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Small intestinal transit time in critically ill patients using endoscopic video capsule

Introduction

We investigated the small bowel transit time and pathophysiological changes using a video capsule in ICU patients with head injuries. The gut was only recently recognized as pivotal in the disease process of critical illness; hence, work is needed to improve our understanding of how bowel dysfunction impacts healing. We hypothesized that new diagnostic technology such as wireless capsule endoscopy, which allows real-time investigation of the small bowel, will show that the small bowel transit time is increased in critically ill patients with brain injuries.

Methods

We recruited 32 patients older than 18 years in this prospective, controlled, IRB-approved trial. Their authorized representatives gave written, informed consent. Sixteen of them were neuro-ICU patients with mild-to-moderate brain injury (GCS 6–14) who required a feeding tube. The control group consisted of 16 ambulatory patients. A small capsule containing a video camera (PillCam™) was positioned in each patient's proximal small intestine at the time of endoscopic feeding tube insertion. Sensors on the patient's abdomen picked up signals the capsule transmitted to allow real-time video recording of the gut. Two independent observers analyzed the data.

Results

The average small bowel transit time for neuro-ICU patients ranged from 144 to 480 minutes (median 344 min, mean 338 min). For the ambulatory patients, the range was 228–389 minutes (median 250 min, mean 279 min). All five patients with small bowel transit times greater than 400 minutes were neuro-ICU patients. The mean difference between the groups was 59 minutes (95% CI: -17 to 135), and according to a Mann–Whitney rank-sum test P = 0.184.

Conclusion

The current results suggest that the small bowel transit time is not significantly increased in our critical care patients.

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Rauch, S., Krueger, K., Sessler, D. et al. Small intestinal transit time in critically ill patients using endoscopic video capsule. Crit Care 12, P319 (2008). https://doi.org/10.1186/cc6540

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Keywords

  • Feeding Tube
  • Ambulatory Patient
  • Bowel Dysfunction
  • Endoscopic Video Capsule
  • Critical Care Patient