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Intestinal motility disturbances in intensive care patients pathogenesis and clinical impact
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Intestinal motility disturbances in intensive care patients pathogenesis and clinical impact
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Journal Article
Intestinal motility disturbances in intensive care patients pathogenesis and clinical impact
2007
Overview
Gastrointestinal motility disturbances in critically ill patients are frequent in the ICU setting, causing considerable discomfort and are associated with increased rates of morbidity and mortality. This review focuses on the pathophysiological basis of intestinal motility, the major patterns of pathological motility alterations, the impact on patient outcome, and current therapeutic options.
Intestinal motility is controlled by the enteric nervous system, modulated by hormones and extrinsic afferent and efferent neurons. Pathological motility disturbances can affect the stomach, small bowel, and colon separately or in combination. Changes in esophageal motor activity contribute to the aspiration of gastric juice, whereas early enteral feeding most frequently fails due to gastric intolerance. Disturbances in digestive and interdigestive motility patterns and the inability to switch motor activity from the interdigestive to the digestive pattern also contribute to feeding disability and thus to increased morbidity and mortality as well.
The therapeutic options for motility disturbances in critically ill patients include the adjustment of electrolyte imbalances, tailored fluid management, early enteral feeding, appropriate management of catecholamines and drugs used for analgosedation, and prokinetic drugs. Unfortunately, the therapeutic options for treating motility disturbances in ICU patients are still limited. This situation requires careful assessment of ICU patients with respect to gut motility disturbances and their pathophysiological mechanisms and an individually tailored treatment to prevent further aggravation of existing motility disturbances.
Publisher
Springer,Springer Nature B.V
Subject
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
/ Biological and medical sciences
/ Clinical death. Palliative care. Organ gift and preservation
/ Food
/ Humans
/ Intestinal Diseases - chemically induced
/ Intestinal Diseases - drug therapy
/ Motility
/ Patients
/ Stomach
/ Transfusions. Complications. Transfusion reactions. Cell and gene therapy
