Anest. intenziv. Med. 2016;27(1):19-24

Metabolic consequences of bowel damage in intensive careIntesive Care Medicine - Review Article

Z. Zadák^*, A. Tichá, R. Hyšpler

Centrum pro výzkum a vývoj, Fakultní nemocnice Hradec Králové

The role of the bowel function in intensive care has for a long time been underestimated, but the metabolic or barrier function failure can have potentially fatal consequences. This review summarises the major causes and effects of functional and metabolic bowel damage with emphasis on critical care. The dominant factors are intestinal hypoperfusion consequent to systemic hypotension, restriction of blood flow in the mesenteric area due to partial obstruction of the mesenteric arteries, inflammation, toxicity of xenobiotics to enterocytes, infectious agents, lack of nutrients, ionizing radiation and mechanical bowel damage. The necessary tests for possible comorbidities, which further deteriorate bowel function, and specific intestinal laboratory examinations are described. These include saccharide absorption tests and determination of D-lactate or intestinal fatty acid binding protein.
The basic options for nutritional improvement of the intestinal function are listed, namely minimal enteral nutrition, the current recommendations for prevention of intestinal damage in critical care and the cholinergic vagal stimulation concept using choline precursors. Adherence to such regimens facilitates restoration or maintenance of the gut function.

Keywords: gut barrier; multiorgan failure; intestinal fatty acid binding protein; sepsis; re-feeding

Received: August 20, 2015; Accepted: October 28, 2015; Published: February 1, 2016  Show citation