Falla gastrointestinal en pacientes con ventilación mecánica: prevalencia y factores asociados

Abstract

Background

Enteral nutrition intolerance occurs in approximately 30% of patients undergoing invasive mechanical ventilation (IMV) for more than 72 hours and is associated with worse clinical outcomes. Gastrointestinal dysfunction includes the digestive symptoms frequently observed in this context, while gastrointestinal failure (GIF) represents its most severe form. The aim of this study was to determine the prevalence of GIF in patients receiving IMV and to analyze its relationship with hemodynamic, pharmacological, and ventilatory factors.

Materials and methods

This was a prospective, single-center cohort study conducted over six months in an intensive care unit (ICU). Patients admitted for medical or surgical causes with an intact gastrointestinal tract on admission and receiving enteral nutrition via feeding tube were included. GIF was classified according to standardized clinical criteria, and associated hemodynamic, ventilatory, and pharmacological variables were evaluated.

Results

A total of 77 patients were included; 22 developed GIF, corresponding to a prevalence of 28.5%. Among these, 63.6% (n = 14) presented grade II GIF, 22.7% (n = 5) grade III, and 13.6% (n = 3) grade IV. No significant differences were found in vasopressor use, lactate levels, or opioid administration between GIF severity groups. Body mass index (BMI), PEEP, and intra-abdominal pressure were associated with greater severity in the bivariate analysis.

Conclusions

The prevalence of gastrointestinal failure is a relatively frequent complication in critically ill patients receiving enteral nutrition. Body mass index, PEEP levels, and intra-abdominal pressure were associated with greater severity, highlighting the importance of these parameters in the assessment and monitoring of patients at risk of gastrointestinal failure. The findings in this study suggest the need for further research into factors associated with the progression of gastrointestinal failure to optimize clinical management in the ICU.