Acute gastrointestinal injury in the intensive care unit: diagnosis, severity assessment, and general approaches to correction
https://doi.org/10.24884/2078-5658-2025-22-1-110-119
Abstract
Introduction. Acute gastrointestinal injury is a polymorphic syndrome with many causes.
The objective was to consider modern aspects of diagnosis and assessment of severity of acute gastrointestinal injury.
Materials and methods. The literature search and analysis was performed in the medical information systems PubMed and eLibrary, using following keywords: acute gastrointestinal injury, intestinal fatty acid-binding protein (iFABP), D-lactate.
Results. In this review, we present the scores for assessment of the severity of acute gastrointestinal tract injury, clinical symptoms, as well as new laboratory and instrumental diagnostic approaches.
Conclusion. Early detection of this category of patients is vital to provide a personalized intensive therapy aimed at restoration of adequate function of the gastrointestinal tract.
About the Authors
M. M. Sokolova
The first city clinical hospital named after E. E. Volosevich ; Northern State Medical University
Russian Federation
Russian Federation
Sokolova Mariia M., Associate Professor of the Department of Anesthesiology and Intensive Care
1, Suvorova str., Arkhangelsk, 163001
51, Troickiy pr., Arkhangelsk, 163000
T. N. Semenkova
The first city clinical hospital named after E. E. Volosevich ; Northern State Medical University
Russian Federation
Russian Federation
Semenkova Tatyana N., Postgraduate Student of the Department of Anesthesiology and Intensive Care
1, Suvorova str., Arkhangelsk, 163001
51, Troickiy pr., Arkhangelsk, 163000
I. S. Zabaldin
The first city clinical hospital named after E. E. Volosevich ; Northern State Medical University
Russian Federation
Russian Federation
Zabaldin Igor S., Postgraduate Student of the Department of Anesthesiology and Intensive Care
1, Suvorova str., Arkhangelsk, 163001
51, Troickiy pr., Arkhangelsk, 163000
V. V. Kuzkov
The first city clinical hospital named after E. E. Volosevich ; Northern State Medical University
Russian Federation
Russian Federation
Kuzkov Vsevolod V., Dr. of Sci. (Med.), Associate Professor of the Department of Anesthesiology and Intensive Care
1, Suvorova str., Arkhangelsk, 163001
51, Troickiy pr., Arkhangelsk, 163000
M. Yu. Kirov
The first city clinical hospital named after E. E. Volosevich ; Northern State Medical University
Russian Federation
Russian Federation
Kirov Mikhail Y., Dr. of Sci. (Med.), Professor, Corresponding Member of the RAS, Head of the Department of Anesthesiology and Intensive Care
1, Suvorova str., Arkhangelsk, 163001
51, Troickiy pr., Arkhangelsk, 163000
References
1. Zvyagin A. A., Bavykina I. A., Nastausheva T. L., Bavykin D. V. Intestinal Fatty Acid Binding Protein as the Promising Marker of Small Intestine Permeability. Rossiyskiy Vestnik Perinatologii i Pediatrii, 2020, vol. 65, no. 6, pp. 29–33. (In Russ.). https://doi.org/10.21508/1027-4065-2020-65-6-29-33.
2. Kostina O. V., Didenko N. V., Galova E. A. et al. Fatty acid-binding protein as a marker of intestinal damage and potential predictor of mortality in acute period of burn disease. Russian Journal of Anesthesiology and Reanimatology, 2023, no. 6, pp. 52–57. (In Russ.). https://doi.org/10.17116/anaesthesiology202306152.
3. Li I. A., Noskova K. K., Varvanina G. G., Tkachenko E. V. The fatty acids binding protein (I-FABP) — the diagnostic marker of damage of the intestine. Laboratory Service, 2015, vol. 4, no. 1, pp. 26–29. (In Russ.). https://doi.org/10.17116/labs20154126-29.
4. Ponomaryova A. D., Leyderman I. N., Kasherininov I. Yu. Acute Mesenteric Ischemia in Critically Ill Patients. Possibilities of Laboratory Diagnostics. Systematic Literature Review and Meta-Analysis. Russian Sklifosovsky Journal “Emergency Medical Care”, 2022, vol. 11, no. 2, pp. 317–323. (In Russ.). https://doi.org/10.23934/2223-9022-2022-11-2-317-323.
5. Sivkov O. G., Leiderman I. N., Lutciuk M. I. Predicting of enteral nutrition intolerance in critically ill patients. Annals of Critical Care, 2020, vol. 4, pp. 120–126. (In Russ.). https://doi.org/10.21320/1818-474X-2020-4-120-126.
6. Tretiakova E. P., Shen N. P., Tretiakov D. S. Impact of gastrointestinal insufficiency on survival of children with sepsis. Russian Journal of Anesthesiology and Reanimatology, 2023, no. 5, pp. 40–43. (In Russ.). https://doi.org/10.17116/anaesthesiology202305140.
7. Turgunov Ye. M., Ogizbayeva A. V., Mugazov M. M., Asamidanova S. G. Biomarkers of intestinal wall damage in multiple organ dysfunction syndrome. Russian Journal of Anesthesiology and Reanimatology, 2024, no. 2, pp. 114–120. (In Russ.). https://doi.org/10.17116/anaesthesiology2024021114.
8. Apfel C. C., Kranke P., Piper S. et al. Nausea and vomiting in the postoperative phase. Expert- and evidence-based recommendations for prophylaxis and therapy. Anaesthesist, 2007, vol. 56, no. 11, pp. 1170–1180. https://doi.org/10.1007/s00101-007-1210-0.
9. Assadian A., Assadian O., Senekowitsch C. et al. Plasma D-lactate as a potential early marker for colon ischaemia after open aortic reconstruction. Eur J Vasc Endovasc Surg, 2006, vol. 31, no. 5, pp. 470–474. https://doi.org/10.1016/j.ejvs.2005.10.031.
10. Baid H. A critical review of auscultating bowel sounds. Br J Nurs, 2009, vol. 21, no. 18, pp. 1125–9. https://doi.org/10.12968/bjon.2009.18.18.44555.
11. Berger M. M., Hurni C. A. Management of gastrointestinal failure in the adult critical care setting. Curr Opin Crit Care, 2022, vol. 28, no. 2, pp. 190–197. https://doi.org/10.1097/MCC.0000000000000924.
12. Blaser A., Padar M., Tang J. et al. Citrulline and intestinal fatty acid-binding protein as biomarkers for gastrointestinal dysfunction in the critically ill. Anaesthesiol Intensive Ther, 2019, vol. 51, no. 3, pp. 230–239. https://doi.org/10.5114/ait.2019.86049.
13. Bongaerts G. P., Tolboom J. J., Naber A. H. et al. Role of bacteria in the pathogenesis of short bowel syndrome-associated D-lactic acidemia. Microb Pathog, 1997, vol. 22, no. 5, pp. 285–293. https://doi.org/10.1006/mpat.1996.0122.
14. Casaer M. P., Mesotten D., Hermans G. et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med, 2011, vol. 365, no. 6, pp. 506–517. https://doi.org/10.1056/NEJMoa1102662.
15. Cheatham M. L., Malbrain M. L., Kirkpatrick A. et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Intensive Care Med, 2007, vol. 33, no. 6, pp. 951–962. https://doi.org/10.1007/s00134-007-0592-4.
16. Crenn P., Messing B., Cynober L. Citrulline as a biomarker of intestinal failure due to enterocyte mass reduction. Clin Nutr, 2008, vol. 27, no. 3, pp. 328–339. https://doi.org/10.1016/j.clnu.2008.02.005.
17. Doig G. S., Heighes P. T., Simpson F. et al. Early enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta-analysis of randomized controlled trials. Intensive Care Med, 2009, vol. 35, no. 12, pp. 2018–2027. https://doi.org/10.1007/s00134-009-1664-4.
18. Fruhwald S., Kainz J. Effect of ICU interventions on gastrointestinal motility. Curr Opin Crit Care, 2010, vol. 16, no. 2, pp. 159–164. https://doi.org/10.1097/MCC.0b013e3283356679.
19. Gralnek I. M., Stanley A. J., Morris A. J. et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021. Endoscopy, 2021, vol. 53, no. 3, pp. 300–332. https://doi.org/10.1055/a-1369-5274.
20. Granholm A., Krag M., Marker S. et al. Predictors of gastrointestinal bleeding in adult ICU patients in the SUP-ICU trial. Acta Anaesthesiol Scand, 2021, vol. 65, no. 6, pp. 792–800. https://doi.org/10.1111/aas.13805.
21. Herbers A. H., Blijlevens N. M., Donnelly J. P. et al. Bacteraemia coincides with low citrulline concentrations after high-dose melphalan in autologous HSCT recipients. Bone Marrow Transplant, 2008, vol. 42, no. 5, pp. 345–349. https://doi.org/10.1038/bmt.2008.170.
22. Herbert M. K., Holzer P. Standardized concept for the treatment of gastrointestinal dysmotility in critically ill patients-current status and future options. Clin Nutr, 2008, vol. 27, no. 1, pp. 25–41. https://doi.org/10.1016/j.clnu.2007.08.001.
23. Hu B., Sun R., Wu A. et al. Severity of acute gastrointestinal injury grade is a predictor of all-cause mortality in critically ill patients: a multicenter, prospective, observational study. Crit Care, 2017, vol. 21, no. 1, pp. 188. https://doi.org/10.1186/s13054-017-1780-4.
24. Hurt R. T., McClave S. A. Gastric residual volumes in critical illness: what do they really mean? Crit Care Clin, 2010, vol. 26, no. 3, pp. 481–490. https://doi.org/10.1016/j.ccc.2010.04.010.
25. Kimball E. J. Intra-abdominal hypertension and abdominal compartment syndrome: a current review. Curr Opin Crit Care, 2021, vol. 27, no. 2, pp. 164–168. https://doi.org/10.1097/MCC.0000000000000797.
26. Koratala A. Venous congestion assessment using point-of-care Doppler ultrasound: Welcome to the future of volume status assessment. Clin Case Rep, 2021, vol. 9, no. 3, pp. 1805–1807. https://doi.org/10.1002/ccr3.3840.
27. Krajewski K., Siewert B., Eisenberg R. L. Colonic dilation. AJR Am J Roentgenol, 2009, vol. 193, no. 5, pp. 363–372. https://doi.org/10.2214/AJR.09.3353.
28. Kreymann K. G., Berger M. M., Deutz N. E. et al. ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin Nutr, 2006, vol. 25, no. 2, pp. 210–223. https://doi.org/10.1016/j.clnu.2006.01.021.
29. Leffler D. A., Lamont J. T. Treatment of Clostridium difficile-associated disease. Gastroenterology, 2009, vol. 136, no. 6, pp. 1899–1912. https://doi.org/10.1053/j.gastro.2008.12.070.
30. Matejovic M., Huet O., Dams K. et al. Medical nutrition therapy and clinical outcomes in critically ill adults: a European multinational, prospective observational cohort study (EuroPN). Crit Care, 2022, vol. 26, no. 1, pp. 143. https://doi.org/10.1186/s13054-022-03997-z.
31. Messmer A. S., Zingg C., Müller M. et al. Fluid overload and mortality in adult critical care patients-a systematic review and meta-analysis of observational studies. Crit Care Med, 2020, vol. 48, no. 12, pp. 1862–1870. https://doi.org/10.1097/CCM.0000000000004617.
32. Mutlu G. M., Mutlu E. A., Factor P. GI complications in patients receiving mechanical ventilation. Chest, 2001, vol. 119, no. 4, pp. 1222–1241. https://doi.org/10.1378/chest.119.4.1222.
33. Nielsen C., Lindholt J. S., Erlandsen E. J. et al. D-lactate as a marker of venous-induced intestinal ischemia: an experimental study in pigs. Int J Surg, 2011, vol. 9, no. 5, pp. 428–432. https://doi.org/10.1016/j.ijsu.2011.04.004.
34. Papadia C., Sherwood R. A., Kalantzis C. et al. Plasma citrulline concentration: a reliable marker of small bowel absorptive capacity independent of intestinal inflammation. Am J Gastroenterol, 2007, vol. 102, no. 7, pp. 1474–1482. https://doi.org/10.1111/j.1572-0241.2007.01239.x.
35. Peoc’h K., Nuzzo A., Guedj K. et al. Diagnosis biomarkers in acute intestinal ischemic injury: so close, yet so far. Clin Chem Lab Med, 2018, vol. 56, no. 3, pp. 373–385. https://doi.org/10.1515/cclm-2017-0291.
36. Petrović N., Žunić M., Pejčić A. et al. Factors associated with gastrointestinal dysmotility in critically ill patients. Open Med (Wars), 2023, vol. 18, no. 1, pp. 20230820. https://doi.org/10.1515/med-2023-0820.
37. Piton G., Capellier G. Biomarkers of gut barrier failure in the ICU. Curr Opin Crit Care, 2016, vol. 2, no. 2, pp. 152–160. https://doi.org/10.1097/MCC.0000000000000283.
38. Reintam A., Parm P., Kitus R. et al. Gastrointestinal symptoms in intensive care patients. Acta Anaesthesiol Scand, 2009, vol. 53, no. 3, pp. 318–324. https://doi.org/10.1111/j.1399-6576.2008.01860.x.
39. Reintam A., Parm P., Kitus R. et al. Gastrointestinal failure score in critically ill patients: a prospective observational study. Crit Care, 2008, vol. 12, no. 4, pp. 90. https://doi.org/10.1186/cc6958.
40. 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, vol. 38, no. 3, pp. 384–394. https://doi.org/10.1007/s00134-011-2459-y.
41. Reintam Blaser A., Padar M., Mändul M. et al. Development of the Gastrointestinal Dysfunction Score (GIDS) for critically ill patients – A prospective multicenter observational study (iSOFA study). Clin Nutr, 2021, vol. 40, no. 8, pp. 4932–4940. https://doi.org/10.1016/j.clnu.2021.07.015.
42. Ridley E. J., Davies A. R. Practicalities of nutrition support in the intensive care unit: the usefulness of gastric residual volume and prokinetic agents with enteral nutrition. Nutrition, 2011, vol. 27, no. 5, pp. 509–512. https://doi.org/10.1016/j.nut.2010.10.010.
43. Salamone S., Liu R., Staller K. Gastrointestinal dysmotility in critically ill patients: bridging the gap between evidence and common misconceptions. J Clin Gastroenterol, 2023, vol. 57, no. 5, pp. 440–450. https://doi.org/10.1097/MCG.0000000000001772.
44. Sapin V., Nicolet L., Aublet-Cuvelier B. et al. Rapid decrease in plasma D-lactate as an early potential predictor of diminished 28-day mortality in critically ill septic shock patients. Clin Chem Lab Med, 2006, vol. 44, no. 4, pp. 492–496. https://doi.org/10.1515/CCLM.2006.086.
45. Shi H., Wu B., Wan J. et al. The role of serum intestinal fatty acid binding protein levels and D-lactate levels in the diagnosis of acute intestinal ischemia. Clin Res Hepatol Gastroenterol, 2015, vol. 39, no. 3, pp. 373–378. https://doi.org/10.1016/j.clinre.2014.12.005.
46. Sobhian B., Kröpfl A., Hölzenbein T. et al. Increased circulating D-lactate levels predict risk of mortality after hemorrhage and surgical trauma in baboons. Shock, 2012, vol. 37, no. 5, pp. 473–477. https://doi.org/10.1097/SHK.0b013e318249cb96.
47. Voth M., Lustenberger T., Relja B. et al. Is I-FABP not only a marker for the detection abdominal injury but also of hemorrhagic shock in severely injured trauma patients? World J Emerg Surg, 2019, vol. 14, no. 49. https://doi.org/10.1186/s13017-019-0267-9.
48. Wang J., Yu L., Xia Y. et al. Diagnostic value of citrulline and intestinal fatty acid binding protein on acute gastrointestinal injury in critical patients: a prospective study of 530 patients. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 2017, vol. 29, no. 11, pp. 999–1003. https://doi.org/10.3760/cma.j.issn.2095-4352.2017.11.00.
49. Wiesen P., Van Gossum A., Preiser J.C. Diarrhoea in the critically ill. Curr Opin Crit Care, 2006, vol. 12, no. 2, pp. 149–154. https://doi.org/10.1097/01.ccx.0000216583.64804.46.
Review
For citations:
Sokolova M.M., Semenkova T.N., Zabaldin I.S., Kuzkov V.V., Kirov M.Yu. Acute gastrointestinal injury in the intensive care unit: diagnosis, severity assessment, and general approaches to correction. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2025;22(1):110-119. (In Russ.) https://doi.org/10.24884/2078-5658-2025-22-1-110-119
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