ISSN (print) 1726-9806     ISSN (online) 1818-474X
No. 4 (2020), DIAGNOSTIC APPROACHES FOR CRITICAL CONDITIONS
No. 4 (2020)
DIAGNOSTIC APPROACHES FOR CRITICAL CONDITIONS

Predicting of enteral nutrition intolerance in critically ill patients

Published 16.11.2020
Oleg G. Sivkov
Neftyanik Hospital, Tyumen, Russia; Tyumen State Medical Universuty, Tyumen, Russia
https://orcid.org/0000-0002-7694-9293
I.N. Leiderman
Almazov National Medical Research Center, St. Petersburg, Russia
https://orcid.org/0000-0001-8519-7145
M.I. Lutciuk
Multidisciplinari clinical medical centrе “Medicinsky gorod”, Tyumen, Russia
https://orcid.org/0000-0003-0353-5847
#2020-4
PDF_2020-04_120-126 (Russian)
HTML_2020-04_120-126 (Russian)

Keywords

critical illness
enteral nutrition
gastrointestinal tract
paracetamol

How to Cite

Sivkov O.G., Leiderman I., Lutciuk M.I. Predicting of enteral nutrition intolerance in critically ill patients. Annals of Critical Care. 2020;(4):120–126. doi:10.21320/1818-474X-2020-4-120-126.
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver AMA ГОСТ

Download Citation

Endnote/Zotero/Mendeley (RIS) BibTeX

Statistics

Annotation views: 415
PDF_2020-04_120-126 (Russian) downloads: 139
HTML_2020-04_120-126 (Russian) downloads: 165

Language

English Русский

Most reader

Social Networks

Keywords

Abstract

Even in minimal morphological changes in the gut of critically ill patients, its ability to absorb nutrients, drugs and, in particular, acetaminophen is reduced. The search for a simple and accessible clinical method that allows to assess the possibility of enteral nutrition is rather actual.

Objectives. To assess the prognostic value of the acetaminophen enteral absorption test in critically ill patients.

Materials and methods. A single-center, prospective study was performed in 52 patients of the polyvalent intensive care unit (ICU). 0.5 g of paracetamol was injected into the nasogastric tube. After 10, 15, 20, 30, 40, 50 and 90 minutes 5 ml of venous blood was taken to determine the concentration of acetaminophen in it. On the next day the volume of administered and excreted via a nasogastric tube was recorded. Healthy volunteers (n = 12) were included in group 1. The second group (n = 15) — a positive balance by the nasogastric tube, the third group (n = 15) — the balance is negative up to 500 ml per day, the fourth — negative up to 1 liter per day, the fifth group — negative > 1 liter per day. To identify the predictive value and cutoff values of the test, the data were analyzed using the logistic regression method, and then the ROC analysis. The authors received permission from the local ethics committee.

Results. The most informative time interval for determining the concentration of paracetamol in the blood after its administration into the stomach is the interval from 15 to 30 minutes. A strong correlation (r = 0.846 [p < 0.001]) was found out between the results of the paracetamol test and the daily balance by the nasogastric tube. ROC analysis showed that the sensitivity of this test exceeds 86 %, and the specificity was about 75 %. If the concentration of paracetamol in the blood is > 6.17 μg/ml successful total enteral nutrition is highly possible. The values of this indicator in the range from 2.47 μg/ml to 6.17 μg/ml can serve as the basis for the implementation of the method of partial enteral nutrition. We believe that at levels < 2.47 mcg/ml, a “minimal enteral nutrition” attempt can be made.

Conclusion. The paracetamol absorption test in critically ill patients can be considered as an independent predictor of the feasibility of enteral zone feeding. Predicting enteral feeding intolerance using the paracetamol absorption test in critically ill patients can significantly improve the efficacy and safety of tube feeding method.

PDF_2020-04_120-126 (Russian)
HTML_2020-04_120-126 (Russian)

References

  1. Reintam A., Parm P., Kitus R., et al. Gastrointestinal symptoms in intensive care patients. Acta Anaesthesiol Scand. 2009; 53(3): 318–324. DOI: 10.1111/j.1399-6576.2008.01860.x
  2. Zhang D., Fu R., Li Y., et al. Comparison of the clinical characteristics and prognosis of primary versus secondary acute gastrointestinal injury in critically ill patients. J Intensive Care. 2017; 5: 26. Published 2017 Apr 20. DOI: 10.1186/s40560-017-0221-4
  3. Nguyen T., Frenette A.J., Johanson C., et al. Impaired gastrointestinal transit and its associated morbidity in the intensive care unit. J Crit Care. 2013; 28(4): 537.e11–537.e5.37E17. DOI: 10.1016/j.jcrc.2012.12.003
  4. Reintam Blaser A., Malbrain M.L., Starkopf J., et al. Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Med. 2012; 38(3): 384–394. DOI: 10.1007/s00134-011-2459-y
  5. Reintam Blaser A., Poeze M., Malbrain M.L., et al. Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective multicentre study. Intensive Care Med. 2013; 39(5): 899–909. DOI: 10.1007/s00134-013-2831-1
  6. Miyauchi T., Ishikawa M., Tashiro S., et al. Acetaminophen absorption test as a marker of small bowel transplant rejection. Transplantation. 1997; 63(8): 1179–1182. DOI: 10.1097/00007890-199704270-00020
  7. Singer P., Blaser A.R., Berger M.M., et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019; 38(1): 48–79. DOI: 10.1016/j.clnu.2018.08.037
  8. RU2484467C1 Способ оценки возможности энтерального питания у больных с абдоминальным сепсисом. Сивков О.Г., Лейдерман И.Н., Кармацких О.Г., Пономарева М.А., Евдокимова А.А. Патент на изобретение RU 2484467 C1, 10.06.2013. Заявка № 2012103631/15 от 02.02.201.
  9. Способ определения возможности еюнального питания при синдроме кишечной недостаточности. Сивков О.Г., Лейдерман И.Н., Зайцев Е.Ю., Сивков А.О. Патент на изобретение RU 2640021 C, 25.12.2017. Заявка № 2017110168 от 27.03.2017.
  10. Vincent J.L., Moreno R., Takala J., et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996; 22(7): 707–710. DOI: 10.1007/BF01709751
  11. Knaus W.A., Draper E.A., Wagner D.P., et al. APACHE II: a severity of disease classification system. Crit Care Med. 1985; 13(10): 818–829.
  12. Couturier O., Bodet-Milin C., Querellou S., et al. Gastric scintigraphy with a liquid-solid radiolabelled meal: performances of solid and liquid parameters. Nucl Med Commun. 2004; 25(11): 1143–1150. DOI: 10.1097/00006231-200411000-00013
  13. Ueno T., Tanaka A., Hamanaka Y., Suzuki T. Serum drug concentrations after oral administration of paracetamol to patients with surgical resection of the gastrointestinal tract. Br J Clin Pharmacol. 1995; 39(3): 330–332. DOI: 10.1111/j.1365-2125.1995.tb04457.x
  14. Miyauchi T., Ishikawa M., Tashiro S., et al. Acetaminophen absorption test as a marker of small bowel transplant rejection. Transplantation. 1997; 63(8): 1179–1182. DOI: 10.1097/00007890-199704270-00020
  15. Willems M., Quartero A.O., Numans M.E. How useful is paracetamol absorption as a marker of gastric emptying? A systematic literature study. Dig Dis Sci. 2001; 46(10): 2256–2262. DOI: 10.1023/a:1011935603893
  16. Martinez E.E., Panciotti C., Pereira L.M., et al. Gastrointestinal Hormone Profiles Associated with Enteral Nutrition Tolerance and Gastric Emptying in Pediatric Critical Illness: A Pilot Study. JPEN J Parenter Enteral Nutr. 2020; 44(3): 472–480. DOI: 10.1002/jpen.1678
  17. Kar P., Jones K.L., Horowitz M., et al. Measurement of gastric emptying in the critically ill. Clin Nutr. 2015; 34(4): 557–564. DOI: 10.1016/j.clnu.2014.11.003
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.