All mechanically ventilated patients subsequently admitted to the mixed surgical-medical ICU of Tartu University Hospital from September 2006 to September 2007 were screened for inclusion in the present prospective study. Patients treated for at least 24 hours were included in further analyses. On admission, the following parameters were recorded: age, sex, body mass index, readmission rate, diabetes, Acute Physiology and Chronic Health Evaluation (APACHE II) score [15 (link)], surgical profile, and whether laparatomy was performed (immediately before ICU admission or during the first 24 hours). The SOFA score [16 (link)], mean arterial pressure, central venous pressure, peak inspiratory pressure, positive end-expiratory pressure, IAP, lactate, fluid gain, use of vasopressor/inotrope and sedation were recorded on daily basis. Gastrointestinal function of the patients was assessed daily using the GIF score, described in Table 1 .
Enteral feeding was started as early as possible, but not within the first days after major abdominal surgery. Food intolerance (FI) was diagnosed when applied enteral feeding appeared to be unsuccessful and had to be discontinued because of repeated or profuse vomiting, high gastric residuals, ileus, severe diarrhoea, abdominal pain, or distension. FI was not registered when the patient was electively not fed during the first 3 days after laparatomy. Gastric residual volume was considered to be high when it exceeded the volume previously given enterally.
IAP was measured via the bladder, with patients in the supine position, using the closed loop system repeated measurements technique [17 (link)]. The IAP was measured at least twice a day when normal values were recorded, and at least four times a day if IAP was found to be elevated above 12 mmHg. Mean and maximum values of IAP were documented daily. Mean IAP was used to calculate daily GIF score. IAH was defined as an IAP that was persistently 12 mmHg or greater [18 (link)]. Abdominal compartment syndrome was defined as an IAP that was persistently above 20 mmHg, along with onset of a new organ failure. Gastrointestinal failure was considered to be present when IAH and FI occurred simultaneously.
ICU, 28-day and 90-day mortality, and durations of ICU stay and mechanical ventilation were primary outcome parameters. The SOFA+GIF score was calculated each day by summarizing the SOFA score and the GIF score of the respective day in each patient.
The Ethics Committee of the University of Tartu approved the study. Written informed consent was not considered necessary for the study, because it was observational in nature. No special interventions were applied. All of the data were rendered anonymous before analysis, and no harm resulted from the study that could be weighed against benefit.
Enteral feeding was started as early as possible, but not within the first days after major abdominal surgery. Food intolerance (FI) was diagnosed when applied enteral feeding appeared to be unsuccessful and had to be discontinued because of repeated or profuse vomiting, high gastric residuals, ileus, severe diarrhoea, abdominal pain, or distension. FI was not registered when the patient was electively not fed during the first 3 days after laparatomy. Gastric residual volume was considered to be high when it exceeded the volume previously given enterally.
IAP was measured via the bladder, with patients in the supine position, using the closed loop system repeated measurements technique [17 (link)]. The IAP was measured at least twice a day when normal values were recorded, and at least four times a day if IAP was found to be elevated above 12 mmHg. Mean and maximum values of IAP were documented daily. Mean IAP was used to calculate daily GIF score. IAH was defined as an IAP that was persistently 12 mmHg or greater [18 (link)]. Abdominal compartment syndrome was defined as an IAP that was persistently above 20 mmHg, along with onset of a new organ failure. Gastrointestinal failure was considered to be present when IAH and FI occurred simultaneously.
ICU, 28-day and 90-day mortality, and durations of ICU stay and mechanical ventilation were primary outcome parameters. The SOFA+GIF score was calculated each day by summarizing the SOFA score and the GIF score of the respective day in each patient.
The Ethics Committee of the University of Tartu approved the study. Written informed consent was not considered necessary for the study, because it was observational in nature. No special interventions were applied. All of the data were rendered anonymous before analysis, and no harm resulted from the study that could be weighed against benefit.
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