Annika Reintam

Gastrointestinal Failure score in critically ill patients: a prospective observational study

IntroductionThere are no universally accepted diagnostic criteria for gastrointestinal failure in critically ill patients. In the present study we tested whether the occurrence of food intolerance (FI) and intra-abdominal hypertension (IAH), combined in a 5-grade scoring system for assessment of gastrointestinal function (the Gastrointestinal Failure [GIF] score), predicts mortality. The prognostic value of the GIF score alone and in combination with the Sequential Organ Failure Assessment (SOFA) score is evaluated, and the incidence and outcome of gastrointestinal failure is described relative to the GIF score.MethodsA total of 264 subsequently hospitalized patients, who were mechanically ventilated on admission and stayed in the intensive care unit (ICU) for longer than 24 hours, were prospectively studied. GIF score was documented daily as follows: 0 = normal gastrointestinal function; 1 = enteral feeding with under 50% of calculated needs or no feeding 3 days after abdominal surgery; 2 = FI or IAH; 3 = FI and IAH; and 4 = abdominal compartment syndrome (ACS). Admission parameters and mean GIF and SOFA scores for the first 3 days were used to predict ICU outcome.ResultsFI developed in 58.3%, IAH in 27.3%, and both together in 22.7% of patients. The mean GIF score for the first 3 days in the ICU was identified as an independent risk factor for mortality (odds ratio = 3.02, 95% confidence interval = 1.63 to 5.59; P < 0.001). The GIF score integrated into the SOFA score allowed better prediction of ICU mortality than did the SOFA score alone, and was an independent predictor of mortality (odds ratio = 1.49, 95% confidence interval = 1.28 to 1.74; P < 0.001). The development of gastrointestinal failure (FI plus IAH) was associated with significantly higher ICU and 90-day mortality.ConclusionThe GIF score is useful for classifying information on the gastrointestinal system. The mean GIF score during the first 3 days in the ICU had high prognostic value for ICU mortality. Development of gastrointestinal failure is associated with significantly impaired outcome.

Gastrointestinal symptoms in intensive care patients

Background: Gastrointestinal (GI) problems are not uniformly assessed in intensive care unit (ICU) patients and respective data in available literature are insufficient. We aimed to describe the prevalence, risk factors and importance of different GI symptoms.

Intraabdominaalse hüpertensiooni esinemissagedus intensiivravihaigetel ja mõju ravitulemustele

Tartu Ulikooli Kliinikumi uldintensiivraviosakonnas on intraabdominaalset rohku (IAP) moodetud alates 2004. aastast. Kaesolev too keskendub intraabdominaalse hupertensiooni (IAH) esinemissageduse ja moju uurimisele kahe perioodi vordluses: esimesel perioodil (2004–2006) moodeti IAP ainult eeldatava riskiruhma patsientidel, teisel perioodil (2006–2007) aga koikidel aparaadihingamisel olevatel haigetel. Uurimuse tulemustest selgus, et IAH riskiruhm on raskesti kindlaks tehtav. Jalgides IAPd ainult valitud patsientidel, jaab osa IAH-patsientidest identifi tseerimata. IAH esineb intensiivravipatsientidel sageli ning on seotud nende suurema suremusega. Eesti Arst 2008; 87(3):191−197