Focus on gastrointestinal system in critically ill patients
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EDITORIAL
Focus on gastrointestinal system in critically ill patients Emmanuel Weiss1,2,3* and Yaseen M. Arabi4,5,6 © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Gastrointestinal or intra-abdominal conditions are a major cause for critical illness. Additionally, critical illness precipitates gastrointestinal injury, mediated by hypoperfusion, hypoxia and systemic inflammation. This editorial reviews the progress made on gastrointestinal issues in critically ill patients as reported in the recent literature in order to focus on the needs for further research in this field (Fig. 1). A recent observational study by the Abdominal Sepsis Study (AbSeS) group (from European Society of Intensive Care Medicine) included 2621 patients with intraabdominal infection from 42 countries and reported a mortality rate of 29.1% [1]. The prevalence of antimicrobial resistance was 26.3%; worryingly, it was equally common in community-acquired as in hospital-acquired infection [1]. Beside intra-abdominal infections, one of the important manifestations of gastrointestinal injury during critical illness is stress-related gastrointestinal bleeding (GIB), which is associated with an increased risk of death and length of stay in the intensive care unit (ICU) [2]. Nevertheless, the routine prescription of stress ulcer prophylaxis has been debated. Because new relevant trials including the SUP-ICU trial [3] were recently published, Barbateskovic et al. [4] conducted a systematic review with meta-analysis of randomized clinical trials assessing the effects of proton pump inhibitor (PPI) or histamine-2-receptor antagonists (H2RA) versus placebo or no prophylaxis on mortality, GIB and adverse events. Analyzing 42 trials that included 6899 ICU patients, they
*Correspondence: [email protected] 1 Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, 100 bld du general Leclerc, 92110 Clichy, France Full author information is available at the end of the article
found that PPI or H2RA did not improve mortality but reduced GIB by almost 50%. However, the effects on clinically important GIB, serious adverse events, healthrelated quality of life, myocardial ischemia, pneumonia and C. difficile enteritis remained inconclusive. In order to identify patients at highest risk of GIB, Granholm et al. [5] performed a systematic review and meta-analysis assessing potential predictors of clinically important GIB and overt GIB in adult ICU patients. While confirming the low incidences of clinically important GIB and overt GIB (ranging from 0.6 to 2.8% and 1.3 to 12.8%, respectively), they found that acute kidney injury (AKI), coagulopathy, shock and chronic liver disease were consistently associated with increased risk of GIB. In a specific meta-analysis, Butler et al. [6] reported that systemic corticosteroids might also increase the risk of clinically important GIB slightly, although this effect was unclear given the rarity of bleeding events, infrequent trial reporting and high risk of bias
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