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Association of Gastric Antrum Echodensity and Acute Gastrointestinal Injury in Critically Ill Patients

Overview
Journal Nutrients
Date 2022 Mar 12
PMID 35276925
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Abstract

(1) Background: Acute muscle inflammation leads to increased sonographic echodensity. We developed a technique to characterize the echodensity of the gastric antrum wall and assess its feasibility in evaluating the severity of acute gastrointestinal injury (AGI); (2) Methods: The B-mode images of the gastric antrum of each enrolled patient were obtained daily by point-of-care ultrasound (POCUS). The 50th percentile, 85th percentile, and mean value of the grayscale distribution according to histogram analysis (ED50, ED85, and EDmean, respectively) were used to characterize the gastric antrum echodensity. Consistency and correlation analyses were performed to evaluate the feasibility and reproducibility of gastric antrum echodensity measurement. The association of gastric antrum echodensity with the severity of AGI and its ability to predict feeding intolerance (FI) were analyzed; (3) Results: In total, 206 POCUS images of 43 patients were analyzed. The gastric antrum echodensity measurements had sufficient intra- and inter-investigator reliabilities (intraclass correlation coefficient >0.9 for all parameters). The ED50 showed a significant upward trend as AGI severity increased, as well as ED85 and EDmean (p for trend <0.001, respectively). Patients who experienced FI had a higher ED50 (67.8 vs. 56.1, p = 0.02), ED85 (85.6 vs. 71.2, p = 0.01), and EDmean (70.3 vs. 57.6, p = 0.01) upon enteral feeding initiation; (4) Conclusions: Measurement of gastric antrum echodensity was technically feasible and reproducible in ventilated patients. Increased gastric antrum echodensity was associated with greater severity of AGI. Patients with higher gastric antrum echodensity upon enteral nutrition initiation via a nasogastric tube were more likely to develop FI.

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References
1.
Patel J, Kozeniecki M, Peppard W, Peppard S, Zellner-Jones S, Graf J . Phase 3 Pilot Randomized Controlled Trial Comparing Early Trophic Enteral Nutrition With "No Enteral Nutrition" in Mechanically Ventilated Patients With Septic Shock. JPEN J Parenter Enteral Nutr. 2019; 44(5):866-873. DOI: 10.1002/jpen.1706. View

2.
Gao T, Cheng M, Xi F, Chen Y, Cao C, Su T . Predictive value of transabdominal intestinal sonography in critically ill patients: a prospective observational study. Crit Care. 2019; 23(1):378. PMC: 6880579. DOI: 10.1186/s13054-019-2645-9. View

3.
McClave S, Gualdoni J, Nagengast A, Marsano L, Bandy K, Martindale R . Gastrointestinal Dysfunction and Feeding Intolerance in Critical Illness: Do We Need an Objective Scoring System?. Curr Gastroenterol Rep. 2020; 22(1):1. DOI: 10.1007/s11894-019-0736-z. View

4.
Asrani V, Brown A, Huang W, Bissett I, Windsor J . Gastrointestinal Dysfunction in Critical Illness: A Review of Scoring Tools. JPEN J Parenter Enteral Nutr. 2019; 44(2):182-196. DOI: 10.1002/jpen.1679. View

5.
Watanabe Y, Ikenaga M, Yoshimura E, Yamada Y, Kimura M . Association between echo intensity and attenuation of skeletal muscle in young and older adults: a comparison between ultrasonography and computed tomography. Clin Interv Aging. 2018; 13:1871-1878. PMC: 6174294. DOI: 10.2147/CIA.S173372. View