Gastric feeding intolerance is not caused by mucosal ischemia measured by intragastric air tonometry in the critically ill

• Published in: Clinical nutrition (Edinburgh, Scotland) Vol. 35; no. 3; pp. 731 - 734
• Main Authors: Streefkerk, Jörn O, Beishuizen, Albertus, Groeneveld, A.B. Johan
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.06.2016
• Subjects: Aged; Critical Illness; Critically ill; Enteral Nutrition - adverse effects; Enteral nutrition intolerance; Female; Food Intolerance - epidemiology; Food Intolerance - etiology; Food, Formulated - adverse effects; Gastric ischemia; Gastric Mucosa - blood supply; Gastric residuals; Gastritis - epidemiology; Gastritis - etiology; Gastroenterology and Hepatology; Hospitals, Teaching; Hospitals, University; Humans; Intensive Care Units; Intragastric tonometry; Ischemia - etiology; Ischemia - prevention & control; Male; Manometry; Middle Aged; Netherlands - epidemiology; PCO2 gap; Proof of Concept Study; Reproducibility of Results; Risk Factors; Gastric ischemia; Enteral nutrition intolerance; Critically ill; PCO 2 gap; Gastric residuals; Intragastric tonometry; PCO2 gap; PCO gap
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2015.05.015

Summary Background Gastric mucosal ischemia may be a risk factor for gastrointestinal intolerance to early feeding in the critically ill. Aims To study intragastric PCO2 air tonometry and gastric residual volumes (GRV) before and after the start of gastric feeding. Methods This is a two-center study in intensive care units of a university and teaching hospital. Twenty-nine critically ill, consecutive and consenting patients scheduled to start gastric feeding were studied after insertion of a gastric tonometry catheter and prior to and after start of gastric feeding (500 ml over 1 h), when clinically indicated. Results Blood gasometry and intragastric tonometry were performed prior to and 2 h after gastric feeding. The intragastric to arterial PCO2 gap (normal <8 mm Hg) was elevated in 41% of patients prior to feeding and measured (mean ± standard deviation) 13 ± 20 and 16 ± 23 mm Hg in patients with normal (<100 ml, 42 ± 34 ml, n  = 19) and elevated GRV (250 ± 141 ml, n  = 10, P  = 0.75), respectively. After feeding, the gradient did not increase and measured 27 ± 25 and 23 ± 34 mm Hg, respectively ( P  = 0.80). Conclusion Gastric mucosal ischemia is not a major risk factor for intolerance to early gastric feeding in the critically ill.