Table 1.
Definition, example, and management of acute gastrointestinal (GI) injury
| Grade | Definition | Example | Management |
|---|---|---|---|
| I | The function of the GI tract is partially impaired, expressed as GI symptoms related to a known cause, and perceived as transient | Postoperative nausea and/or vomiting during the first days after abdominal surgery, postoperative absence of bowel sounds, diminished bowel motility in the early phase of shock | Start or increase enteral feeding |
| Re-evaluate daily | |||
| II | The GI tract is not able to perform digestion and absorption adequately to satisfy the nutrient and fluid requirements of the body. There are no changes in general condition of the patient related to GI problems | Gastroparesis with high gastric residuals or reflux, paralysis of the lower GI tract, diarrhea, IAH grade I (IAP 12–15 mmHg), visible blood in gastric content or stool. Feeding intolerance is present if intake of at least 20 kcal/kg BW per day (84 kJ/kg BW per day) via enteral route cannot be achieved within 72 hr of feeding attempt | Start therapy according to the symptom (e.g., prokinetics) |
| Measure IAP | |||
| Start minimal enteral feeding | |||
| Consider postpyloric feeding | |||
| III | Loss of GI function and restoration of GI function is not achieved despite interventions, and the general condition is not improving | Despite treatment, feeding intolerance is persisting: high gastric residuals, persisting GI paralysis, occurrence or worsening of bowel dilatation, progression of IAH to grade II (IAP 15–20 mmHg), low APP (<60 mmHg) Feeding intolerance is present and possibly associated with persistence or worsening of multiple organ dysfunction syndrome | Search for undiagnosed abdominal pathology |
| Continue therapy according to the symptom (e.g., prokinetics) | |||
| Treat IAH | |||
| Try (challenge) minimal feeding and start parenteral nutrition | |||
| IV | Acute GI injury has progressed to become directly and immediately life threatening, with worsening of multiple organ dysfunction syndrome and shock | Bowel ischemia with necrosis, GI bleeding leading to hemorrhagic shock, Ogilvie’s syndrome, abdominal compartment syndrome requiring decompression | Requiring laparotomy or other emergency interventions (e.g., colonoscopy for colonic decompression) |
Based on Reintam Blaser et al. [21].
IAH, intraabdominal hypertension; IAP, intraabdominal pressure; BW, body weight; kJ, kilojoules; APP, abdominal perfusion pressure.