Intestinal motility.pdfVIP

Intensive Care Med (2007) 33:36–44 DOI 10.1007/s00134-006-0452-7 REV IEW Sonja Fruhwald Peter Holzer Helfried Metzler Intestinal motility disturbances in intensive care patients pathogenesis and clinical impact Received: 4 January 2006 Accepted: 17 October 2006 Published online: 18 November 2006 ? Springer-Verlag 2006 S. Fruhwald (
) · H. Metzler Medical University of Graz, Department of Anesthesiology and Intensive Care Medicine, Auenbruggerplatz 29, 8036 Graz, Austria e-mail: sonja.fruhwald@meduni-graz.at Tel.: +43-316-3853027 Fax: +43-316-3853267 P. Holzer Medical University of Graz, Department of Clinical and Experimental Pharmacology, Universit?tsplatz 4, 8010 Graz, Austria Abstract Background: Gastroin- testinal motility disturbances in critically ill patients are frequent in the ICU setting, causing considerable discomfort and are associated with increased rates of morbidity and mortality. This review focuses on the pathophysiological basis of intesti- nal motility, the major patterns of pathological motility alterations, the impact on patient outcome, and cur- rent therapeutic options. Discussion: Intestinal motility is controlled by the enteric nervous system, modulated by hormones and extrinsic afferent and efferent neurons. Pathological motility disturbances can affect the stomach, small bowel, and colon sep- arately or in combination. Changes in esophageal motor activity contribute to the aspiration of gastric juice, whereas early enteral feeding most frequently fails due to gastric intoler- ance. Disturbances in digestive and interdigestive motility patterns and the inability to switch motor activity from the interdigestive to the diges- tive pattern also contribute to feeding disability and thus to increased morbidity and mortality as well. Conclusions: The therapeutic options for motility disturbances in critically ill patients include the adjustment of electrolyte imbalances, tailored fluid management, early enteral feeding, appropriate management of