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Intensive Care Medicine

Published in:

01-10-2007 | Original

Gastric feed intolerance is not increased in critically ill patients with type II diabetes mellitus

Authors: N. Q. Nguyen, S. W. Lam, K. Ching, M. Chapman, R. J. Fraser, R. H. Holloway

Published in: Intensive Care Medicine | Issue 10/2007

Abstract

Objective

To examine the occurrence of feed intolerance in critically ill patients with previously diagnosed type II diabetes mellitus (DM) who received prolonged gastric feeding.

Design and setting

Retrospective study in a level 3 mixed ICU.

Patients

All mechanically ventilated, enterally fed patients (n = 649), with (n = 118) and without type II DM (n = 531) admitted between January 2003 and July 2005.

Interventions

Patients with at least 72 h of gastric feeding were identified by review of case notes and ICU charts. The proportion that developed feed intolerance was determined. All patient received insulin therapy.

Results

The proportion of patients requiring gastric feeding for at least 72 h was similar between patients with and without DM (42%, 50/118, vs. 42%, 222/531). Data from patients with DM were also compared with a group of 50 patients matched for age, sex and APACHE II score, selected from the total non-diabetic group. The occurrence of feed intolerance (DM 52% vs. matched non-DM 50% vs. unselected non-diabetic 58%) and the time taken to develop feed intolerance (DM 62.6 ± 43.8 h vs. matched non-DM 45.3 ± 54.6 vs. unselected non-diabetic 50.6 ± 59.5) were similar amongst the three groups. Feed intolerance was associated with a greater use of morphine/midazolam and vasopressor support, a lower feeding rate and a longer ICU length of stay.

Conclusions

In critically ill patients who require prolonged enteral nutrition, a prior history of DM type II does not appear to be a further risk factor for feed intolerance.

Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler L, Kitabchi A (2002) Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab 87:978–982PubMedCrossRef

Samsom M, Vermeijden JR, Smout AJPM, Van Doorn E, Roelofs J, Van Dam PS, Martens EP, Eelkman-Rooda SJ, Van Berge-Henegouwen GP (2003) Prevalence of delayed gastric emptying in diabetic patients and relationship to dyspeptic symptoms: A prospective study in unselected diabetic patients. Diabetes Care 26:3116–3122PubMedCrossRef

Horowitz M, Wishart JM, Jones KL, Hebbard GS (1996) Gastric emptying in diabetes: an overview. Diabet Med 13:S16–S22PubMed

Kong MF, Horowitz M (2005) Diabetic gastroparesis. Diabet Med 22:13–18PubMedCrossRef

Napolitano LM, Bochicchio G (2000) Enteral feeding of the critically ill. Curr Opin Crit Care 6:136–142CrossRef

ASPEN Board of Directors and the Clinical Guidelines Taskforce (2002) Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr 26:S1–S38

Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P (2003) Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr 27:355–373PubMedCrossRef

Multu G, Multu E, Factor P (2001) Gastrointestinal complications in patients receiving mechanical ventilation. Chest 119:1222–1241CrossRef

Heyland D, Cook DJ, Winder B, Brylowski L, Van de Mark H, Guyatt G (1995) Enteral nutrition in the critically ill patient: a prospective survey. Crit Care Med 23:1055–1060PubMedCrossRef

10.

Mentec H, Dupont H, Bocchetti M, Cani P, Ponche F, Bleichner G (2001) Upper digestive intolerance during enteral nutrition in critically ill patients: Frequency, risk factors, and complications. Crit Care Med 29:1955–1961PubMedCrossRef

11.

Mullen JL, Buzby GP, Matthews D, Smale B, Rosato EF (1980) Reduction of operative morbidity and mortality by combined preoperative and postoperative nutritional support. Ann Surg 192:604–609PubMedCrossRef

12.

Dempsey DT, Mullen JL, Buzby GP (1988) The link between nutritional status and clinical outcome: can nutritional intervention modify it? Am J Clin Nutr 47:352–356PubMed

13.

Schroeder D, Gillanders L, Mahr K (1991) Effects of immediate postoperative enteral nutrition on body composition, muscle function, and wound healing. JPEN J Parenter Enteral Nutr 15:376–383PubMed

14.

Ritz MA, Fraser R, Tam W, Dent J (2000) Impacts and patterns of disturbed gastrointestinal function in critically ill patients. Am J Gastroenterol 95:3044–3052PubMedCrossRef

15.

Chapman MJ, Fraser RJ, Kluger MT, Buist MD, De Nichilo DJ (2000) Erythromycin improves gastric emptying in critically ill patients intolerant of nasogastric feeding. Crit Care Med 28:2334–2337PubMedCrossRef

16.

McClave SA, Snider HL, Lowen CC, McLaughlin A, Greene L, McCombs L, Wright R, Roy R, Schumer M (1992) Use of residual volume as a marker for enteral feeding intolerance: prospective blinded comparison with physical examination and radiographic findings. JPEN J Parenter Enteral Nutr 16:99–105PubMed

17.

Nguyen NQ, Chapman M, Fraser RJ, Bryan L, Holloway RH (2006) Longstanding type II diabetes mellitus is not a risk factor for slow gastric emptying in critically ill patients. Intensive Care Med 32:1365–1670PubMedCrossRef

18.

Nguyen NQ, Fraser R, Chapman M, Bryan L, Holloway RH (2007) Proximal gastric motor function in critically ill patients with type 2 diabetes mellitus. World J Gastroenterol 13:270–275PubMed

19.

Rayner CK, Samsom M, Jones KL, Horowitz (2001) Relationships of upper gastrointestinal motor and sensory function with glycemic control. Diabetes Care 24:371–381PubMedCrossRef

20.

Fraser RJ, Horowitz M, Maddox A, Harding P, Chatteron B, Dent J (1990) Hyperglycaemia slows gastric emptying in type 1 diabetes mellitus. Diabetologia 33:675–680PubMedCrossRef

21.

Van den Berghe G, Wouters PJ, Bouillon R et al. (2003) Outcome benefit of intensive insulin therapy in the critically ill: insulin dose versus glycemic control. Crit Care Med 31:359–366CrossRef

22.

Kao CH, Chang Lai SP, Cheing PU, Yen TC (1998) Gastric emptying in head-injured patients. Am J Gastroenterol 93:1108–1102PubMedCrossRef

23.

De Beaux M, Chapman M, Fraser R, Finnis M, De Keulenaer B, Liberalli D, Satanek M (2001) Enteral nutrition in the critically ill: a prospective survey in an Australian intensive care unit. Anaesth Intensive Care 29:619–622PubMed

24.

El-Sharkawy TY, Szurszewski JH (1978) Modulation of canine antral circular smooth muscle by acetylcholine, noradrenaline and pentagastrin. J Physiol (Lond) 279:309–320

25.

Bech K, Hovendal CP, Andersen D (1982) Effect of dopamine on pentagastrin-stimulated gastric antral motility in dogs with gastric fistula. Scand J Gastroenterol 17:103–107PubMedCrossRef

26.

McClave SA, Snider HL (2002) Clinical use of gastric residual volumes as a monitor for patients on enteral tube feeding. JPEN J Parenter Enteral Nutr 26:S43–S50PubMedCrossRef

27.

Valensi P, Paries J, Attali JR (2003) Cardiac autonomic neuropathy in diabetic patients: influence of diabetes duration, obesity, and microangiopathic complications-the French multicenter study. Metab Clin Exp 52:815–820PubMed

Title: Gastric feed intolerance is not increased in critically ill patients with type II diabetes mellitus
Authors: N. Q. Nguyen
S. W. Lam
K. Ching
M. Chapman
R. J. Fraser
R. H. Holloway
Publication date: 01-10-2007
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 10/2007
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-007-0712-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Gastric feed intolerance is not increased in critically ill patients with type II diabetes mellitus

Abstract

Objective

Design and setting

Patients

Interventions

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design and setting

Patients

Interventions

Results

Conclusions

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