Incidence of gastrointestinal failure in intensive care unit patients: retrospective and prospective study

Objective

To describe the incidence of gastrointestinal failure (GIF) and ICU performance according to GIF in a comparison of two studies.

Design

A retrospective study of year 2002 and a prospective study in 2004.

Patients

A total of 468 adult patients of surgical and medical emergency were admitted to the ICU of Tartu University Hospital in 2002 and 201 patients were admitted in 2004. Patients' mean APACHE II score at admission was 13.7 in 2002 and 16.4 in 2004, the mean SOFA score at admission was 6.8 and 6.7 points, respectively. Sixteen percent of patients in 2002 and 19% in 2004 were transferred from other hospitals. A total 20.0% and 17.5%, respectively, were reanimated before admission.

Measurements

For 2002, data from patients' charts were retrospectively recorded in a computerized database. In 2004 an existing database was used in a prospective manner. In both studies GIF was defined as documented gastrointestinal problems (including food intolerance, gastrointestinal haemorrhage and ileus) in patient data. Comparative analysis was performed with the chi-square test.

Results

Incidence of GIF was 15.6% in the retrospective study and 29.9% in the prospective study (P < 0.001). Patients with GIF had significantly higher mortality, longer ICU stay (Table 1) and longer mechanical ventilation period. Mortality of GIF patients was 67.1% in 2002 and 51.7% in 2004 (P = 0.051), while overall mortality was 28.2% versus 24.4% (P = 0.343).

Table 1

Conclusions

Gastrointestinal failure is a relevant clinical problem with high mortality, prolonged ICU stay and mechanical ventilation. Without special attention, part of the GIF cases remain unnoticed. Development of universal definition and further studies are therefore needed.