EP.FRI.332 Impact of Nutritional Deficit in Emergency Surgery (INDIcatES): A cohort study

Background Emergency laparotomy is associated with significant morbidity. Nutritional status is an important factor that can influence outcomes, particularly in this setting where temporary gastrointestinal failure can occur. This study aims to compare the performance of three nutrition risk tools in predicting time without enteral nutrition. Methods A prospective cohort study was conducted across two sites (NCT04696367). Patients undergoing NELA eligible procedures were invited to participate. Data collected included demographics, surgical diagnosis, surgical procedure, and surgical outcomes. Nutrition risk was assessed using three tools: MUST score, the Nutritional Risk Index (NRI), and Nutritional Risk Score 2002 (NRS). Results In total, 56 patients were recruited of whom 21 had small bowel obstruction. Median age was 69 years and 23 participants were female. Overall, 23 participants (41.8%) were identified as high risk using the MUST score, compared to 11 (20.0%) using NRS and 4 (8.9%) using NRI. Median time to return to normal enteral intake was 10 days (IQR 7-14). 91%, 90%, and 95% of those identified as low risk according to MUST, NRS, and NRI respectively were without enteral intake for 5 days or more. The median complication index score was 15 (IQR 0-34). There was no significant difference in duration of time without intake or complications seen in any of the nutritional risk groups. Discussion This study shows that patients undergoing emergency laparotomy spend a prolonged time without enteral intake. Current tools do not adequately stratify the likelihood of prolonged starvation at baseline, or in light of surgical findings.

Gastrointestinal failure score in children with traumatic brain injury

Background To review the value of the gastrointestinal failure (GIF) score in children with different degrees of traumatic brain injury (TBI) by analyzing the correlation between outcome and gastrointestinal function. Methods A total of 165 children with TBI who were diagnosed and treated in the surgical intensive care unit (SICU) for longer than 72 h between August 2017 and September 2019 were analyzed. Admission parameters included sex, age, Glasgow Coma Scale (GCS) score, body mass index (BMI), leukocyte count, C-reactive protein (CRP), hemoglobin (Hb), hematocrit (Hct), blood glucose, lactic acid, procalcitonin (PCT), albumin, plasma osmotic pressure, prothrombin time (PT) and activated partial thromboplastin time (APTT). To predict outcomes, the Pediatric Sequential Organ Failure Assessment (SOFA) score, Pediatric Clinical Illness Score (PCIS), and mean GIF score for the first three days were combined. Results The percentage of patients with gastrointestinal dysfunction on the first day was 78.8 %. Food intolerance (FI) and intra-abdominal hypertension (IAH) developed in 36.4 and 21.8 % of the patients, respectively. The GIF score and mean GIF score for the first three days were significantly different between children with different degrees of TBI (P < 0.05); these scores were also significantly different between patients who died and those who survived (P < 0.05). The mean GIF score for the first three days was identified as an independent risk factor for mortality (odds ratio > 1, 95 % confidence interval = 1.457 to 16.016, P < 0.01), as was the PCIS. Receiver operating characteristic (ROC) curve analysis suggested that the mean GIF score for the first three days had the same calibrating power as the PCIS in discriminating the risk of death of children. Conclusions The incidence of gastrointestinal dysfunction in children with TBI is high. The GIF score has the ability to reflect the status of the gastrointestinal system. The mean GIF score for the first three days has high prognostic value for ICU mortality in the SICU.

Effect of Dexmedetomidine on Intestinal Barrier in Patients Undergoing Gastrointestinal Surgery - A Single-Centre Randomized Clinical Trial

Background: Gastrointestinal failure accounts for death in critically ill patients. This study aimed to explore the effect and mechanism of dexmedetomidine (DEX) in intestinal barrier function in critically ill patients undergoing gastrointestinal surgery.Methods: Patients undergoing gastrointestinal surgery were randomized into a DEX group (n=21) or an MID group (n=21). Sufentanil was used in both groups for analgesia. In the DEX group, DEX was loaded (1 µg/kg) before sedation and was infused (0.7 µg/kg/h) during sedation. The mean arterial pressure (MAP), heart rate (HR), borborygmus resumption time (BRT), first defecation time (FDT), stay of ICU and hospital were observed. The DAO, D-LAC, TNF-α, IL-6 and α7nAChR levels in plasma or haemocytes were detected before the start of the sedation (0 h) and after the sedation (24 h).Results: There were no significant differences in age, sex, BMI, APACHE II score, SOFA (P>0.05). The MAP between 0 and 24 h presented no significant difference between the groups (P > 0.05), but HR was significantly slower in the DEX group (P=0.042). The recovery time of bowel sounds was significantly earlier in the DEX group (P=0.034). Both of the stay of ICU (P=0.016) and hospital (P=0.031) were significantly shorter in the DEX group. The expression of α7nAChR in the DEX group was significantly higher at 24 h than at 0 h (P=0.002). The D-LAC decreased significantly in the DEX group than MID group at 24 h (P=0.016).Conclusions: DEX maintained the integrity of the intestinal barrier in patients undergoing gastrointestinal surgery through the cholinergic anti-inflammatory pathway.Trial registration:ChiCTR1900024367. Registered 7 July 2019-Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=40832

Gastrointestinal Failure Score in Children with Traumatic Brain Injury

Background: To review the value of the gastrointestinal failure (GIF) score in children with different degrees of traumatic brain injury (TBI) by analyzing the correlation between outcome and gastrointestinal function. Methods: A total of 165 children with TBI who were diagnosed and treated in the surgical intensive care unit (SICU) for longer than 72 h between August 2017 and September 2019 were analyzed. Admission parameters included sex, age, Glasgow Coma Scale (GCS) score, body mass index (BMI), leukocyte count, C-reactive protein (CRP), hemoglobin (Hb) and hematocrit (Hct), blood glucose, lactic acid, procalcitonin (PCT), albumin, plasma osmotic pressure, prothrombin time (PT) and activated partial thromboplastin time (APTT). To predict outcomes, the Pediatric Sequential Organ Failure Assessment (SOFA) score, Pediatric Clinical Illness Score (PCIS), and mean GIF score for the first three days were combined. Results: The percent of patients with gastrointestinal dysfunction on the first day was 78.8%. Food intolerance (FI) and intra-abdominal hypertension (IAH) developed in 36.4% and 21.8% of the patients, respectively. The GIF score and mean GIF score for the first three days in children with different degrees of TBI were significantly different (P<0.05); these scores were also significantly different between patients who died and those who survived (P<0.05). The mean GIF score for the first three days was identified as an independent risk factor for mortality (odds ratio>1, 95% confidence interval=1.457 to 16.016, P<0.01), as was the PCIS. Receiver operating characteristic (ROC) curve analysis suggested that the mean GIF score for the first three days had the same calibrating power as the PCIS in discriminating the risk of death of children. Conclusion: The incidence of gastrointestinal dysfunction in children with TBI is high. The GIF score has the ability to reflect the status of the gastrointestinal system. The mean GIF score for the first three days has high prognostic value for ICU mortality in the SICU.

Gastrointestinal Failure Score in Children with Traumatic Brain Injury

Purposes: To review the value of the gastrointestinal failure (GIF) score in children with different degrees of traumatic brain injury (TBI) by analyzing the correlation between outcome and gastrointestinal function. Methods: A total of 165 children with TBI who were diagnosed and treated in the surgical intensive care unit (SICU) for longer than 72 h between August 2017 and September 2019 were retrospectively analyzed. Admission parameters included sex, age, Glasgow Coma Scale (GCS) score, body mass index (BMI), leukocyte count, C-reactive protein (CRP), hemoglobin (Hb) and hematocrit (Hct), blood glucose, lactic acid, procalcitonin (PCT), albumin, plasma osmotic pressure, prothrombin time (PT) and activated partial thromboplastin time (APTT). To predict outcomes, the Sequential Organ Failure Assessment (SOFA) score, Pediatric Clinical Illness Score (PCIS), and mean GIF score for the first three days were combined. Results: The percent of patients with gastrointestinal dysfunction on the first day was 78.8%. Food intolerance (FI) and intra-abdominal hypertension (IAH) developed in 36.4% and 21.8% of the patients, respectively. The GIF score and mean GIF score for the first three days in children with different degrees of TBI were significantly different (P<0.05); these scores were also significantly different between patients who died and those who survived (P<0.05). The mean GIF score for the first three days was identified as an independent risk factor for mortality (odds ratio>1, 95% confidence interval=1.457 to 16.016, P<0.01), as was the PCIS. Receiver operating characteristic (ROC) curve analysis suggested that the mean GIF score for the first three days had the same calibrating power as the PCIS in discriminating the risk of death of children. Conclusion: The incidence of gastrointestinal dysfunction in children with TBI is high. The GIF score has the ability to reflect the status of the gastrointestinal system. The mean GIF score for the first three days has high prognostic value for ICU mortality in the SICU.

Gastrointestinal Failure Score in Children with Traumatic Brain Injury

PurposesTo review the value of the gastrointestinal failure (GIF) score in children with different degrees of traumatic brain injury (TBI) by analyzing the correlation between outcome and gastrointestinal function.MethodsA total of 165 children with TBI who were diagnosed and treated in the surgical intensive care unit (SICU) for longer than 72 h between August 2017 and 2019 were retrospectively analyzed. Admission parameters were sex, age, Glasgow Coma Scale (GCS) score, body mass index (BMI), leukocyte count, C-reactive protein (CRP), hemoglobin (Hb) and hematocrit (Hct), blood glucose, lactic acid, procalcitonin (PCT), albumin, plasma osmotic pressure, prothrombin time (PT) and activated partial thromboplastin time (APTT). In order to predict outcome, Sequential Organ Failure Assessment (SOFA) score, Pediatric Clinical Illness Score (PCIS) and mean GIF score for the first three days were also combined.ResultsThe percent of patients with gastrointestinal dysfunction on the first day was 78.8%. Food intolerance (FI) developed in 36.4% and intra-abdominal hypertension (IAH) in 21.8% of patients. The GIF score and mean GIF score for the first three days in children with different degrees of TBI were significantly different (P<0.05); they were also significantly different between those who died and those who survived (P<0.05). The mean GIF score for the first three days was identified as an independent risk factor for mortality (odds ratio>1, 95% confidence interval=1.457 to 16.016, P<0.01), as was the PCIS. Receiver operating characteristic (ROC) curve analysis suggested that the mean GIF score for the first three days had the same calibrating power as the PCIS in discriminating the risk of death of children.ConclusionThe incidence of gastrointestinal dysfunction in children with TBI is high. The GIF score has its ability to judge gastrointestinal system. The mean GIF score for the first three days has high prognostic value for ICU mortality in the SICU.

COMPARATIVE-AGE CHARACTERISTICS OF THE STATE OF THE NEUROVEGATIVE REGULATION OF THE GASTROINTESTINAL TRACT IN INTENSIVE CARE PATIENTS

Introduction. The autonomic nervous system is considered to be the leading adapter of the body to changing conditions of existence The intestine is subjected to massive irritating effects, and therefore is actively regulated by the autonomic nervous system, and itself, at the same time, is its regulator. In intensive care conditions, autonomic reactions change under the influence of critical state inducers. The purpose of the study: a comparative analysis of the neurovegetative regulation of the gastrointestinal tract in patients under intensive care in an age-related aspect. Materials and methods. Under observation were 70 patients in need of intensive care. Of these, 30 are children of the first month of life and 40 are adult patients. The study applied methods of cardiointervalography and assessment of the degree of gastrointestinal failure syndrome. The results of the study. The analysis of cardiointervalograms showed a relatively equal tension of the sympathetic part of the autonomic nervous system, regardless of age. However, in children, in comparison with adults, a more pronounced relative dysbalance of autonomic regulation in favor of humoral sympathetic influences is noted, which significantly increases the stress index in childhood. Despite the pronounced activity of the humoral channel for regulating autonomic homeostasis, it was not a factor affecting the severity of gastrointestinal failure syndrome. Therefore, this factor may be trigger in the formation of intestinal dysfunction, but not determining in the formation of its severity. Correlation in the adult group indicates the predominance of parasympathetic influences in the formation of gastrointestinal failure syndrome. Among children, unlike adults, the formation of this syndrome is associated not only with changes in the parasympathetic department, but with hypersympaticotonia. Conclusions. Regardless of the age, in patients with intensive care, an increase in tension of the sympathetic part of the autonomic nervous system is noted. In children, compared with adults, a markedly pronounced activity of humoral sympathetic influences was noted. At the same time, parasympathetic activity is the decisive factor in the progression of gastrointestinal failure syndrome in adults, and hypersympathicotonia in children.