Predictive value of transabdominal intestinal sonography in critically ill patients: a prospective observational study

Tao Gao, Min-Hua Cheng, Feng-Chan Xi, Yan Chen, Chun Cao, Ting Su, Wei-Qin Li, Wen-Kui Yu, Tao Gao, Min-Hua Cheng, Feng-Chan Xi, Yan Chen, Chun Cao, Ting Su, Wei-Qin Li, Wen-Kui Yu

Abstract

Background: This study examined the feasibility of transabdominal intestinal ultrasonography in evaluating acute gastrointestinal injury (AGI).

Methods: A total of 116 patients were included. Intestinal ultrasonography was conducted daily within 1 week after admission to the intensive care unit. Ultrasonography indicators including intestinal diameter, changes in the intestinal folds, thickness of the intestinal wall, stratification of the intestinal wall, and intestinal peristalsis (movement of the intestinal contents) were observed to determine the acute gastrointestinal injury ultrasonography (AGIUS) score. The gastrointestinal and urinary tract sonography ultrasound (GUTS) protocol score was also calculated. During the first week of the study, the gastrointestinal failure (GIF) score was determined daily. The correlations between transabdominal intestinal scores (AGIUS and GUTS) and the GIF score were analyzed to clarify the feasibility of evaluating AGI through observation of the intestine. The utility of intestinal ultrasonography indicators in predicting feeding intolerance was investigated to improve the ability of clinicians to manage AGI.

Results: A total of 751 ultrasonic examinations were performed with 511 images (68%) considered to be of "good quality." AGIUS and GUTS scores differed significantly between AGI patients (GIF score 0-2) and non-AGI patients (GIF score 3-4) (p < 0.001). Both scores correlated positively with GIF score (r = 0.54, p < 0.001; r = 0.66, p < 0.001). These ultrasonography indicators could predict feeding intolerance, with an area under the receiver operating characteristic curve of 0.60 (0.48-0.71; intestinal diameter), 0.76 (0.67-0.85; intestinal folds), 0.71 (0.62-0.80; wall thickness), 0.77 (0.69-0.86; wall stratification), and 0.78 (0.68-0.88; intestinal peristalsis). Compared to patients with a normal rate of peristalsis (5-10/min), patients with abnormal peristalsis rates (< 5/min or > 10/min) have increased risk for feeding intolerance (16/83 vs. 25/33, p < 0.001).

Conclusions: The transabdominal intestinal ultrasonography represents an effective means for assessing gastrointestinal injury in critically ill patients. Intestinal ultrasonography indicators, especially the degree of intestinal peristalsis, may be used to predict feeding intolerance.

Trial registration: ClinicalTrial.gov, NCT03589248. Registered 04 July 2018-retrospectively registered.

Keywords: Abdominal hypertension; Abdominal pressure; Acute gastrointestinal injury; GUTS protocol; POCUS; Ultrasound.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Examples of intestinal US images showing increased intestinal diameter, shortened intestinal folds, thickened intestinal walls, and stratified intestinal walls. a Increased intestinal diameter. b Shortened intestinal folds (solid arrow) and thickened intestinal walls (dotted arrow). c Stratified intestinal wall (solid arrow)
Fig. 2
Fig. 2
Enrollment flowchart
Fig. 3
Fig. 3
The evolution of SOFA with increasing AGIUS scores
Fig. 4
Fig. 4
The evolution of SOFA with increasing GUTS scores
Fig. 5
Fig. 5
ROC curve analysis for use of AGIUS, GIF, or GUTS score to predict 28-day mortality. Variables included in analyses were the maximum value within the first week
Fig. 6
Fig. 6
Normal transabdominal intestinal ultrasonography. This is a 36-year-old male. The intestine was screened with a curvilinear probe (5 MHz). The image shows normal intestinal diameter (

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