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Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Pediatr+Crit+Care+Med 2015 ; 16 (9): 828-36 Nephropedia Template TP
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Gastric Dysmotility in Critically Ill Children: pathophysiology, diagnosis and management #MMPMID26218259
Martinez EE; Douglas K; Nurko S; Mehta NM
Pediatr Crit Care Med 2015[Nov]; 16 (9): 828-36 PMID26218259show ga
Objective: We aimed to review gastric dysmotility in critically ill children: (a) its pathophysiology, with a focus on critical care diseases and therapies that affect gastric motility, (b) diagnostic methodologies, and (c) current and future potential therapies. Data Sources: Eligible studies were identified from PubMed and MEDLINE. Study Selection: Literature search included the following key terms, ?gastric emptying?, ?gastric motility/ dysmotility?, ?gastrointestinal motility/ dysmotility?, ?nutrition intolerance?, and ?gastric residual volume?. Studies since 1995 were identified and reviewed for inclusion by the authors. Data Extraction & Data Synthesis: We present a review of the current literature related to the physiology, pathophysiology, diagnostic methodologies and available therapies for gastric dysmotility in the critically ill child with a focus on gastric emptying (GE). Delayed GE, a common presentation of gastric dysmotility, is present in up to 50% of critically ill children. It is associated with the potential for aspiration, ventilator- associated pneumonia, inadequate delivery of enteral nutrition and may affect the efficacy of enteral medications, all of which may be result in poor patient outcomes. Gastric motility is affected by critical illness and its associated therapies. Currently available diagnostic tools to identify GE at the bedside have not been systematically studied and applied in this cohort. Gastric residual volume measurement, used as an indirect marker of delayed GE in pediatric intensive care units around the world, may be inaccurate. Conclusion: Gastric dysmotility is common in critically ill children, and impacts patient safety and outcomes. However, it is poorly understood, inadequately defined, and current therapies are limited and based on scant evidence. Understanding gastric motility, and developing accurate bedside measures and novel therapies for GE are highly desirable and need to be further investigated.
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Pediatr+Crit+Care+Med 2015 ; 16 (9): 828-36
