Preliminary report of surface electrogastrography in critically ill septic patients after resuscitation

Introduction

Impaired gastrointestinal motility is common in critically ill patients. Multiple conditions such as shock with diminished splanchnic perfusion, surgery, fluid overload, intra-abdominal hypertension, and drugs are responsible for this phenomena. Assessing gastric motility in this setting is complex. Surface electrogastrography (sEGG) is a recent noninvasive technique that determines basal and postprandial gastric motility [1]. Our aim is to study basal gastric motility in critically ill septic patients in the post-resuscitative phase, by sEGG.

Methods

Eligible patients were those admitted to the ICU with diagnosis of septic shock as stated by the Sepsis Conference 2001 [2]. At the moment of the study the patients were in the post-resuscitative phase, defined as normal clinical and laboratory perfusion parameters. sEGG is a noninvasive technique that uses skin abdominal electrodes to record myoelectrical stomach activity. The basal slow wave originates in the proximal stomach and propagates to the antrum with a frequency of approximately 3 cycles per minute (cpm). Basal activity below 2.4 cpm is defined as bradygastria and above 3.7 cpm as tachygastria [1]. Data were correlated with severity scores, lactate levels, and doses of sedatives. The study was approved by the Ethics Committee of the Hospital Clínico Universidad de Chile.

Results

We recruited 16 patients (10 females). Mean age 62 years (50 to 76) (P = 0.8). APACHE II score 25 (19 to 28) (P = 0.4) and SOFA score 9 (7 to 11) (P = 0.29). Lactate at admission 3.8 mmol/l (1.2 to 6.5) (P = 0.72). Fentanyl total dose 172.7 μg/kg (59 to 256.6) (P = 0.91) and midazolan total dose 3.4 mg/kg (0.1 to 3.1) (P = 0.07). We obtained a reliable register in all the patients and found six patients with bradigastria, three with tachygastria and nine with normal motility. In this small sample size study there was a trend to bradygastria in relation to high total doses of midazolam.

Conclusion

sEGG is a feasible technique in critically ill septic patients. In the post-resuscitative phase 43.8% of patients present normal gastric motility, and 37% showed bradygastria. Future research is warranted in order to find risk factors of gastrointestinal dismotility.