Gastrointestinal function in critically ill trauma patients using motility capsule technology

Introduction

The aim of this study was to investigate the gastric emptying time and small bowel transit time, using a novel wireless motility capsule in trauma patients with intracranial hemorrhage. We hypothesized that gastric emptying and small bowel transit are delayed.

Methods

We recruited eight trauma patients with intracranial hemorrhage (six male/two female, mean age 40 years, APACHE III score 41 ± 7, Glasgow coma scale 8 ± 2) who were intubated, mechanically ventilated, sedated, and older than 18 years in this prospective, controlled, Institution Review Board-approved trial. The historical control group consisted of 81 healthy volunteers studied in a separate trial (Protocol #122205: Assessment of whole gut transit time using the SmartPill capsule: a multicenter study). A pH, pressure and temperature sensing capsule (SmartPill™; SmartPill Inc., Buffalo, NY, USA) was positioned with a capsule delivery device (AdvanCE™; US Endoscopy, Mentor, OH, USA) into the patient's stomach. The data were transmitted to a recorder attached to the patient's abdomen. The data were analyzed by two independent observers.

Results

There was a significant difference (P = 0.004) in the gastric emptying time for ICU patients, 28.8 ± 31.3 hours (mean ± SD), and healthy volunteers, 3.3 ± 1.1 hours. There was no significant difference between the small bowel transit times in ICU patients, 7.1 ± 3.6 hours, and 4.1 ± 1.6 hours in healthy volunteers. There was no difference in sedation and analgesia consumption between the ICU patients. None of the patients received any proton pump inhibitor or prokinetic medication.

Conclusion

Gastric emptying is significantly delayed in major trauma patients; however, small bowel transit times are similar to those in healthy volunteers.