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Clinical Markers of Gastrointestinal Dysfunction

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Gut Dysfunction in Critical Illness

Part of the book series: Update in Intensive Care and Emergency Medicine ((UICM,volume 26))

Abstract

Physiologic support of failing vital organ function is the “raison d’être” of the intensive care unit (ICU). The development of individual organ dysfunction in the critically ill patient describes a clinical syndrome and defines a series of therapeutic challenges. The challenge of pulmonary failure, manifested as the acute respiratory distress syndrome (ARDS), is to support optimal gas exchange without inducing further iatrogenic lung injury, while that of acute renal failure is to optimize fluid and electrolyte homeostasis without adversely affecting systemic hemodynamic function. In aggregate, graded degrees of vital organ dysfunction comprise the multiple organ dysfunction syndrome (MODS), the leading cause of ICU morbidity and mortality, and the embodiment of the unsolved obstacles to recovery from critical illness [14].

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References

  1. Marshall JC (1991) Multiorgan failure. In: Wilmore DW, Brennan MF, Harken AH, et al (eds) Scientific American Surgery Vol 1 Critical Care, Holcroft J, Meakins JL (eds), Scientific American Medicine, New York, pp 13.1–13.20

    Google Scholar 

  2. Bone R, Balk R, Cerra F, Dellinger RP, et al (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 101: 1644–1655

    Article  PubMed  CAS  Google Scholar 

  3. Deitch EA (1992) Multiple organ failure. Pathophysiology and potential future therapy. Ann Surg 216: 117–134

    Article  PubMed  CAS  Google Scholar 

  4. Beat AL, Cerra FB (1994) Multiple organ failure syndrome in the 1990’s. Systemic inflammatory response and organ dysfunction. JAMA 271: 226–233

    Article  Google Scholar 

  5. Carrico CJ, Meakins JL, Marshall JC, Fry D, Maier RV (1986) Multiple organ failure syndrome. The gastrointestinal tract: The ‘motor’ of MOF. Arch Surg 121: 196–208

    Article  PubMed  CAS  Google Scholar 

  6. Wilmore DW, Smith RJ, O’Dwyer ST, Jacobs DO, Ziegler TR, Wang XD (1988) The gut: A central organ after surgical stress. Surgery 104: 917–923

    PubMed  CAS  Google Scholar 

  7. Deitch EA (1990) The role of intestinal barrier failure and bacterial translocation in the development of systemic infection and multiple organ failure. Arch Surg 125: 403–404

    Article  PubMed  CAS  Google Scholar 

  8. Marshall JC (1995) Multiple organ dysfunction syndrome (MODS). In: Sibbald WJ, Vincent JL (eds) Clinical Trials for the Treatment of Sepsis. Springer-Verlag, Berlin, pp 122–138

    Chapter  Google Scholar 

  9. Cook DJ, Fuller H, Guyatt GH, et al (1994) Risk factors for gastrointestinal bleeding in critically ill patients. N Engl J Med 330: 377–381

    Article  PubMed  CAS  Google Scholar 

  10. Arvidsson D, Rasmussen I, Almqvist P, Niklasson F, Haglund U (1991) Splanchnic oxygen consumption in septic and hemorrhagic shock. Surgery 109: 190–197

    PubMed  CAS  Google Scholar 

  11. Price HL, Deutsch S, Marshall BE, Stephen GW, Behar MG, Neufeld GR (1966) Hemodynamic and metabolic effects of hemorrhage in man with particular reference to the splanchnic circulation. Circ Res 18: 469–474

    PubMed  CAS  Google Scholar 

  12. Gump FE, Price JB, Kinney JM (1970) Whole body and splanchnic blood flow and oxygen consumption measurements in patients with intraperitoneal infection. Ann Surg 171: 321–328

    Article  PubMed  CAS  Google Scholar 

  13. Gottlieb ME, Sarfeh IJ, Stratton H, Goldman ML, Newell JC, Shah DM (1983) Hepatic perfusion and splanchnic oxygen consumption in patients postinjury. J Trauma 23: 836–843

    Article  PubMed  CAS  Google Scholar 

  14. Curling TB (1842) On acute ulceration of the duodenum in cases of burns. Med Chir Tr London 25: 260

    CAS  Google Scholar 

  15. Cushing H (1932) Peptic ulcers and interbrain. Surg Gynecol Obstet 55: 1–34

    Google Scholar 

  16. Skillman JJ, Bushnell LS, Goldman H, Silen W (1969) Respiratory failure, hypotension, sepsis, and jaundice. A clinical syndrome associated with lethal hemorrhage and acute stress ulceration in the stomach. Am J Surg 117: 523–530

    Article  PubMed  CAS  Google Scholar 

  17. Ben-Menachem T, Fogel R, Patel RV, et al (1994) Prophylaxis for stress-related gastric hemorrhage in the medical intensive care unit. A randomized, controlled, single-blind study. Ann Intern Med 121: 568–575

    PubMed  CAS  Google Scholar 

  18. Priebe HJ, Skillman JJ, Bushnell LS, Long PC, Silen W (1980) Antacid versus Cimetidine in preventing acute gastrointestinal bleeding. A randomized trial in 75 critically ill patients. N Engl J Med 302: 424–430

    Article  Google Scholar 

  19. Cook DJ, Witt LG, Cook RJ, Guyatt GH (1991) Stress ulcer prophylaxis in the critically ill: A meta-analysis. Am J Med 91: 519–527

    Article  PubMed  CAS  Google Scholar 

  20. Fiddian-Green RG, McGough E, Pittenger G, Rothman E (1983) Predictive value of intramural pH and other risk factors for massive bleeding from stress ulceration. Gastroenterology 85: 613

    PubMed  CAS  Google Scholar 

  21. Navab F, Steingrub J (1995) Stress ulcer: Is routine prophylaxis necessary? Am J Gastroenterology 90: 708–712

    CAS  Google Scholar 

  22. Perey BJ (1983) Acute necrosis of the gastrointestinal tract: A unified view. Can J Surg 26: 203–204

    PubMed  CAS  Google Scholar 

  23. Haglund U (1994) Gut ischemia. Gut 35: S73–S76

    Article  PubMed  CAS  Google Scholar 

  24. Desai MH, Herndon DN, Rutan RL, Abston S, Linares HA (1991) Ischemic intestinal complications in patients with burns. Surg Gynecol Obstet 172: 257–261

    PubMed  CAS  Google Scholar 

  25. Bell RC, Coalson JJ, Smith JD, Johanson WG (1983) Multiple organ system failure and infection in adult respiratory distress syndrome. Ann Intern Med 99: 293–298

    PubMed  CAS  Google Scholar 

  26. Goris RJA, te Boekhorst TPA, Nuytinck JKS, Gimbrere JSF (1985) Multiple organ failure. Generalized autodestructive inflammation? Arch Surg 120: 1109–1115

    Article  PubMed  CAS  Google Scholar 

  27. Tran DD, Groeneveld ABJ, Van der Meulen J, Nauta JJP, Strack van Schijndel RJM, Thijs LG (1990) Age, chronic disease, sepsis, organ system failure, and mortality in a medical intensive care unit. Crit Care Med 18: 474–479

    Article  PubMed  CAS  Google Scholar 

  28. Nowicki PT, Nankervis CA (1994) The role of the circulation in the pathogenesis of necrotizing enterocolitis. Clin Perinatol 21: 219–234

    PubMed  CAS  Google Scholar 

  29. Harward TR, Brooks DL, Flynn TC, Seeger JM (1993) Multiple organ dysfunction after mesenteric artery revascularization. J Vasc Surg 18: 459–467

    Article  PubMed  CAS  Google Scholar 

  30. Glenn F, Becker CG (1982) Acute acalculous cholecystitis. An increasing entity. Ann Surg 195: 131–136

    Article  PubMed  CAS  Google Scholar 

  31. Howard RJ (1981) Acute acalculous cholecystitis. Am J Surg 141: 194–198

    Article  PubMed  CAS  Google Scholar 

  32. Boland G, Lee MJ, Mueller PR (1993) Acute cholecystitis in the intensive care unit. New Horizons 1: 246–260

    PubMed  CAS  Google Scholar 

  33. Raunest J, Imhof M, Rauen U, Ohmann C, Thon KP, Burrig KF (1992) Acute cholecystitis: A complication in severely injured intensive care patients. J Trauma 32: 433–440

    Article  PubMed  CAS  Google Scholar 

  34. Steinberg W, Tenner S (1994) Acute pancreatitis. N Engl J Med 330: 1198–1210

    Article  PubMed  CAS  Google Scholar 

  35. Kameya S, Hayakawa T, Kameya A, Watanabe T (1986) Hyperamylasemia in patients in an intensive care unit. J Clin Gastroenterol 8: 438–462

    Article  PubMed  CAS  Google Scholar 

  36. Doglio DR, Pusajo JF, Egurrola MA, et al (1991) Gastric mucosal pH as a prognostic index of mortality in critically ill patients. Crit Care Med 19: 1037–1040

    Article  PubMed  CAS  Google Scholar 

  37. Maynard N, Bihari D, Beale R, et al (1993) Assessment of splanchnic oxygenation by gastric tonometry in patients with acute circulatory failure. JAMA 270: 1203–1210

    Article  PubMed  CAS  Google Scholar 

  38. Gutierrez G, Clark C, Brown SD, Price K, Ortiz L, Nelson C (1994) Effect of dobutamine on oxygen consumption and gastric mucosal pH in septic patients. Am J Resp Crit Care Med 150: 324–329

    PubMed  CAS  Google Scholar 

  39. Gutierrez G, Palizas F, Doglio G, et al (1992) Gastric intramucosal pH as a therapeutic index of tissue oxygenation in critically ill patients. Lancet 339: 195–199

    Article  PubMed  CAS  Google Scholar 

  40. Boyd O, MacKay CJ, Lamb G, Bland JM, Grounds RM, Bennett ED (1993) Comparison of clinical information gained from routine blood gas analysis and from gastric tonometry for intramural pH. Lancet 341: 142–146

    Article  PubMed  CAS  Google Scholar 

  41. Friedman G, Berlot G, Kahn RJ, Vincent JL (1995) Combined measurements of blood lactate concentrations and gastric intramucosal pH in patients with severe sepsis. Crit Care Med 23: 1184–1193

    Article  PubMed  CAS  Google Scholar 

  42. Moore FA, Feliciano DV, Andrassy RJ, et al (1992) Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg 216: 172–183

    Article  PubMed  CAS  Google Scholar 

  43. Heyland DK, Cook DJ, Guyatt GH (1994) Does the formulation of enteral feeding products influence infectious morbidity and mortality rates in the critically ill patient? A critical review of the evidence. Crit Care Med 22: 1192–1202

    Article  PubMed  CAS  Google Scholar 

  44. Chang RWS, Jacob S, Lee B (1987) Gastrointestinal dysfunction among intensive care unit patients. Crit Care Med 15: 909

    Article  PubMed  CAS  Google Scholar 

  45. Brinson RR, Pitts VL, Taylor AE (1989) Intestinal absorption of peptide enteral formulas in hypoproteinemic (volume expanded) rats: A paired analysis. Crit Care Med 17: 657–660

    Article  PubMed  CAS  Google Scholar 

  46. Brinson RR, Curtis WD, Singh M (1987) Diarrhea in the intensive care unit: The role of hypoalbuminemia and the response to a chemically defined diet (case reports and review of the literature). J Am Coll Nutr 6: 517–523

    PubMed  CAS  Google Scholar 

  47. Guenter PA, Settle RG, Perlmutter S, Marino PL, DeSimone GA, Rolandelli RH (1991) Tube feeding-related diarrhea in acutely ill patients. J Parent Enteral Nutr 15: 277–280

    Article  CAS  Google Scholar 

  48. Wanke CA, Guerrant RL (1987) Small bowel colonization alone is a cause of diarrhea. Infect Immun 55: 1924–1926

    PubMed  CAS  Google Scholar 

  49. Spapen HD, Duinslaeger L, Diltoer M, Gillet R, Bossuyt A, Huyghens LP (1995) Gastric emptying in critically ill patients is accelerated by adding cisapride to a standard enteral feeding protocol: Results of a prospective, randomized, controlled trial. Crit Care Med 23: 481–485

    Article  PubMed  CAS  Google Scholar 

  50. Ouellette AJ, Hsieh MM, Nosek MT, et al (1994) Mouse Paneth cell defensins: Primary structures and antibacterial activities of numerous cryptidin isoforms. Infect Immun 62: 5040–5047

    PubMed  CAS  Google Scholar 

  51. Tepperman BL, Brown JF, Whittle BJR (1993) Nitric oxide synthase induction and intestinal epithelial cell viability in rats. Am J Physiol 265: G214–G218

    PubMed  CAS  Google Scholar 

  52. Langkamp-Henken B, Donovan TB, Pate LM, Maull CD, Kudsk KA (1995) Increased intestinal permeability following blunt and penetrating trauma. Crit Care Med 23: 660–664

    Article  PubMed  CAS  Google Scholar 

  53. Deitch EA (1990) Intestinal permeability is increased in burn patients shortly after injury. Surgery 107: 411–416

    PubMed  CAS  Google Scholar 

  54. Ziegler TR, Smith RJ, O’Dwyer ST, Demling RH, Wilmore DW (1988) Increased intestinal permeability associated with infection in burn patients. Arch Surg 123: 1313–1319

    Article  PubMed  CAS  Google Scholar 

  55. Murray MJ, Gonze MD, Nowak LR, Cobb CF (1994) Serum D(-)-lactate levels as an aid to diagnosing acute intestinal ischemia. Am Surg 167: 575–578

    Article  CAS  Google Scholar 

  56. Hove H, Mortensen PB (1995) Colonic lactate metabolism and D-lactic acidosis. Dig Dis Sci 40: 320–330

    Article  PubMed  CAS  Google Scholar 

  57. Winchurch RA, Thupari JN, Munster AM (1987) Endotoxemia in burn patients: Levels of circulating endotoxins are related to burn size. Surgery 102: 808–812

    PubMed  CAS  Google Scholar 

  58. Martinez-Pellus AE, Merino P, Bru M, et al (1993) Can selective digestive decontamination avoid the endotoxemia and cytokine activation promoted by cardiopulmonary bypass? Crit Care Med 21: 1684–1691

    Article  PubMed  CAS  Google Scholar 

  59. Van Deventer SJH, Ten Cate JW, Tytgat GNJ (1988) Intestinal endotoxemia. Clinical significance. Gastroenterology 94: 825–831

    PubMed  Google Scholar 

  60. Kivilaakso E, Valtonen VV, Malkamaki M, et al (1984) Endotoxemia and acute pancreatitis: Correlation between the severity of the disease and the anti-enterobacterial common antigen antibody titre. Gut 25: 1065–1070

    Article  PubMed  CAS  Google Scholar 

  61. Endo S, Inada K, Yamada Y, et al (1994) Plasma endotoxin and cytokine concentrations in patients with hemorrhagic shock. Crit Care Med 22: 949–955

    Article  PubMed  CAS  Google Scholar 

  62. Wells CL, Maddaus MA, Simmons RL (1988) Proposed mechanisms for the translocation of intestinal bacteria. Rev Infect Dis 10: 958–979

    Article  PubMed  CAS  Google Scholar 

  63. Sedman PC, Macfie J, Sagar P, et al (1994) The prevalence of gut translocation in humans. Gastroenterology 107: 643–649

    Article  PubMed  CAS  Google Scholar 

  64. Krause W, Matheis H, Wulf K (1969) Fungaemia and funguria after oral administration of Candida albicans. Lancet 1: 598–599

    Article  PubMed  CAS  Google Scholar 

  65. Fiddian-Green RG, Gantz NM (1987) Transient episodes of sigmoid ischemia and their relation to infection from intestinal organisms after abdominal aortic operations. Crit Care Med 15: 835–839

    Article  PubMed  CAS  Google Scholar 

  66. Gaussorgues Ph, Gueugniaud PY, Vedrinne JM, Salord F, Mercatello A, Robert D (1986) Septicémies dans les suites immédiates des arrêts cardio-circulatoires. Réan Soins Intens Med Urg 2: 67–68

    Google Scholar 

  67. Levy J, Van Laethem Y, Verhaegen G, Perpete C, Butzler JP, Wenzel RP (1989) Contaminated enteral nutrition solutions as a cause of nosocomial bloodstream infection: A study using plasmid fingerprinting. J Parent Enteral Nutr 13: 228–234

    Article  CAS  Google Scholar 

  68. Moore FA, Moore EE, Poggetti R, et al (1991) Gut bacterial translocation via the portal vein: A clinical perspective with major torso trauma. J Trauma 31: 629–638

    Article  PubMed  CAS  Google Scholar 

  69. Marshall JC, Christou NV, Meakins JL (1993) The gastrointestinal tract. The “undrained abscess” of multiple organ failure. Ann Surg 218: 111–119

    Article  PubMed  CAS  Google Scholar 

  70. Dyess DL, Garrison RN, Fry DE (1985) Candida sepsis. Implications of polymicrobial blood borne infection. Arch Surg 120: 345–348

    Article  PubMed  CAS  Google Scholar 

  71. Garrison RN, Fry DE, Berberich S, Polk HC (1982) Enterococcal bacteremia. Clinical implications and determinants of death. Ann Surg 196: 43–47

    Article  PubMed  CAS  Google Scholar 

  72. Moore WEC, Holdeman LV (1974) Human fecal flora: The normal flora of 20 Japanese-Hawaiians. Appl Microbiol 27: 961–979

    PubMed  CAS  Google Scholar 

  73. Gorbach SL, Nahas L, Lerner PI, Weinstein L (1967) Studies of intestinal microflora. I. Effects of diet, age, and periodic sampling on numbers of fecal microorganisms in man. Gastroenterology 53: 845–855

    PubMed  CAS  Google Scholar 

  74. Van Der Waaij D (1989) The ecology of the human intestine and its consequences for overgrowth by pathogens such as Clostridium difficile. Ann Rev Microbiol 43: 69–87

    Article  Google Scholar 

  75. Giannella RA, Broitman SA, Zamcheck N (1972) Gastric acid barrier to ingested microorganisms in man: Studies in vivo and in vitro. Gut 13: 251–256

    Article  PubMed  CAS  Google Scholar 

  76. Du Moulin GC, Hedley-Whyte J, Paterson DG, Lisbon A (1982) Aspiration of gastric bacteria in antacid treated patients: A frequent cause of postoperative colonisation of the airway. Lancet 1: 242–245

    PubMed  Google Scholar 

  77. Garvey BM, McCambley JA, Tuxen DV (1989) Effects of gastric alkalization on bacterial colonization in critically ill patients. Crit Care Med 17: 211–216

    Article  PubMed  CAS  Google Scholar 

  78. Heyland D, Mandell LA (1992) Gastric colonization by gram-negative bacilli and nosocomial pneumonia in the intensive care unit patient. Evidence for causation. Chest 101: 187–193

    Article  PubMed  CAS  Google Scholar 

  79. Marshall JC, Christou NV, Horn R, Meakins JL (1988) The microbiology of multiple organ failure. The proximal GI tract as an occult reservoir of pathogens. Arch Surg 123: 309–315

    Article  PubMed  CAS  Google Scholar 

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  1. J. C. Marshall
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Editors and Affiliations

  1. Department of Surgery, Pennsylvania University Hospital, 3400 Spruce Street, 19104, Philadelphia, PA, USA

    J. L. Rombeau

  2. Department of Intensive Care Critical Care Research Program, Kuopio University Hospital, FIN-70211, Kuopio, Finland

    J. Takala

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© 1996 Springer-Verlag Berlin Heidelberg

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Marshall, J.C. (1996). Clinical Markers of Gastrointestinal Dysfunction. In: Rombeau, J.L., Takala, J. (eds) Gut Dysfunction in Critical Illness. Update in Intensive Care and Emergency Medicine, vol 26. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-80224-9_8

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  • DOI: https://doi.org/10.1007/978-3-642-80224-9_8

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-80226-3

  • Online ISBN: 978-3-642-80224-9

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