Gastrointestinal ultrasound in the critically ill: A narrative review and a proposal for a protocol

IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS
Vladislav Mihnovits MD, Annika Reintam Blaser MD, PhD, Thomas Gualdi MS, Alastair Forbes MD, PhD, Gael Piton MD, PhD
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Abstract

Critically ill patients are at risk of presenting with gastrointestinal dysfunction at intensive care unit admission or during their stay. However, identifying gastrointestinal dysfunction is difficult because clinical evaluation is frequently nonspecific and validated biomarkers are lacking. In this context, ultrasound of the digestive tract may help to identify gastrointestinal dysfunction. In this narrative review, we summarize available evidence and propose a protocol for assessment of the gastrointestinal tract with ultrasound. First, we report available evidence from use of four available protocols: the gastrointestinal and urinary tract sonography protocol, the acute gastrointestinal injury ultrasound score, the transabdominal gastrointestinal ultrasound protocol, and the Lai protocol, each addressing somewhat different aspects. Outputs from these protocols have been associated with clinical scores of gastrointestinal failure, feeding intolerance, and 28-day mortality. Second, we describe the potential pitfalls of using ultrasound in the critically ill, such as obesity, abdominal dressings, or the presence of intraluminal gas. Third, we suggest perspectives of ultrasound in monitoring the response to enteral nutrition and for early identification of nonocclusive mesenteric ischemia. Fourth, we propose a structured protocol for gastrointestinal ultrasound describing all the different structures that should be evaluated and provide detailed guidance for a clockwise abdominal examination. In conclusion, the use of a specific and structured protocol might help to identify patients presenting with gastrointestinal dysfunction, guide nutrition, and allow the proposal of pathophysiological hypotheses (complications of enteral nutrition, intra-abdominal infection, bowel ischemia, etc.). The benefit of using a structured protocol requires further investigation.

Abstract Image

重症患者的胃肠道超声检查:叙述性综述和方案建议。
重症患者在进入重症监护室或住院期间有可能出现胃肠功能紊乱。然而,由于临床评估往往没有特异性,而且缺乏有效的生物标志物,因此很难识别胃肠功能紊乱。在这种情况下,消化道超声检查可能有助于识别胃肠功能紊乱。在这篇叙述性综述中,我们总结了现有证据,并提出了用超声波评估胃肠道的方案。首先,我们报告了四种现有方案的可用证据:胃肠道和泌尿道超声检查方案、急性胃肠道损伤超声评分、经腹部胃肠道超声检查方案和 Lai 方案,每种方案都针对不同的方面。这些方案的结果与胃肠功能衰竭、喂养不耐受和 28 天死亡率的临床评分相关。其次,我们介绍了在重症患者中使用超声的潜在隐患,如肥胖、腹部敷料或腔内气体的存在。第三,我们提出了超声在监测肠内营养反应和早期识别非闭塞性肠系膜缺血方面的应用前景。第四,我们提出了一个结构化的胃肠道超声检查方案,描述了应评估的所有不同结构,并为顺时针腹部检查提供了详细指导。总之,使用特定的结构化方案可能有助于识别出现胃肠道功能障碍的患者,指导营养,并提出病理生理假说(肠内营养并发症、腹腔内感染、肠缺血等)。使用结构化方案的益处需要进一步研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.80
自引率
8.80%
发文量
161
审稿时长
6-12 weeks
期刊介绍: The Journal of Parenteral and Enteral Nutrition (JPEN) is the premier scientific journal of nutrition and metabolic support. It publishes original peer-reviewed studies that define the cutting edge of basic and clinical research in the field. It explores the science of optimizing the care of patients receiving enteral or IV therapies. Also included: reviews, techniques, brief reports, case reports, and abstracts.
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