Assessment of physiological barriers to nutrition following critical illness.

BACKGROUND & AIMS: Nutrition may be important for recovery from critical illness. Gastrointestinal dysfunction is a key barrier to nutrition delivery in the Intensive Care Unit (ICU) and metabolic rate is elevated exacerbating nutritional deficits. Whether these factors persist following ICU discharge is unknown. We assessed whether delayed gastric emptying (GE) and impaired glucose absorption persist post-ICU discharge. METHODS: A prospective observational study was conducted in mechanically ventilated adults at 3 time-points: in ICU (V1); on the post-ICU ward (V2); and 3-months after ICU discharge (V3); and compared to age-matched healthy volunteers. On each visit, all participants received a test-meal containing 100 ml of 1 kcal/ml liquid nutrient, labelled with 0.1 g 13C-octanoic acid and 3 g 3-O-Methyl-glucose (3-OMG), and breath and blood samples were collected over 240min to quantify GE (gastric emptying coefficient (GEC)), and glucose absorption (3-OMG concentration; area under the curve (AUC)). Data are mean ± standard error of the mean (SEM) and differences shown with 95% confidence intervals (95%CI). RESULTS: Twenty-six critically ill patients completed V1 (M:F 20:6; 62.0 ± 2.9 y; BMI 29.8 ± 1.2 kg/m2; APACHE II 19.7 ± 1.9), 15 completed V2 and eight completed V3; and were compared to 10 healthy volunteers (M:F 6:4; 60.5 ± 7.5 y; BMI 26.0 ± 1.0 kg/m2). GE was significantly slower on V1 compared to health (GEC difference: -0.96 (95%CI -1.61, -0.31); and compared to V2 (-0.73 (-1.16, -0.31) and V3 (-1.03 (-1.47, -0.59). GE at V2 and V3 were not different to that in health (V2: -0.23 (-0.61, 0.14); V3: 0.10 (-0.27, 0.46)). GEC: V1: 2.64 ± 0.19; V2: 3.37 ± 0.12; V3: 3.67 ± 0.10; health: 3.60 ± 0.13. Glucose absorption (3-OMG AUC0-240) was impaired on V1 compared to V2 (-37.9 (-64.2, -11.6)), and faster on V3 than in health (21.8 (0.14, 43.4) but absorption at V2 and V3 did not differ from health. Intestinal glucose absorption: V1: 63.8 ± 10.4; V2: 101.7 ± 7.0; V3: 111.9 ± 9.7; health: 90.7 ± 3.8. CONCLUSION: This study suggests that delayed GE and impaired intestinal glucose absorption recovers rapidly post-ICU. This requires further confirmation in a larger population. The REINSTATE trial was prospectively registered at www.anzctr.org.au. TRIAL ID: ACTRN12618000370202.

Posttraumatic stress disorder in close Relatives of Intensive Care unit patients' Evaluation (PRICE) study.

BACKGROUND: There is a high risk of post-traumatic stress disorder (PTSD) in relatives of intensive care unit (ICU) patients. AIMS: To determine the prevalence and predictors of symptoms of PTSD in relatives of an Australian critically ill population. METHODS: 108 consecutive patients staying >48 h in a mixed, level three ICU were identified. On day three of admission, their next-of-kin were contacted and consent obtained for a telephonic questionnaire to be done at 90 days after ICU discharge. This consisted of the Hospital Anxiety and Depression Scale and the Impact of Event Scale-Revised (IES-R) questionnaires administered to relatives at 90 days post-discharge from the ICU. An IES-R score of >26 was used to define PTSD symptoms. RESULTS: Eight subjects were excluded because the next-of-kin details were unavailable. 37 other subjects refused to participate. Out of a total of 108, 63 family members were included, including 49 next-of-kin of patients who survived. The prevalence of PTSD symptoms was 41.2% (26/63, 95% CI 29.0-54.4%). The anxiety score was found to be a predictor of PTSD symptoms (relative risk=1.07; 95% CI 1.00-1.14, p=0.05). CONCLUSION: There is a high prevalence of PTSD symptoms in next-of-kin of Australian patients admitted to the ICU. High anxiety scores were a predictor for developing PTSD symptoms.