Gastrointestinal hypomotility
The critically ill positive pressure ventilated patients had decreased gastric and duedonal contractility. This may be due to Cajal cell (GI motor activity control unit) dysfunction, pre-existing disease, endotoxin secretion, corticotropin releasing factor secretion during stress and drugs27,31.
Delayed gastric emptying
Delayed gastric emptying is a common problem in intensive care units in the patients with MV. In the absence of mechanical obstruction, vomiting, bloating feeding intolerance and demonstrating the delayed emptying with ‘gastric emptying scintigraphy’, ‘13C-octanoate acid gastric emptying breath test’ or ‘acetaminophen absorption test’ is sufficient to diagnose.
Supine position, infections, obesity, frequent suctioning, hiatal hernia, increased intracranial pressure and gastrotomy tube placement may lead delayed gastric emptying. Also electrolyte disturbances and hyperglycemia may worsen gastric emptying27,31,57-59.In tube fed children with neuromuscular disorders delayed gastric emptying has been reported. The children with DMA, the delay reported to be related to gastric smooth muscle involvement60,61. Also delayed gastric emptying reported in patients with SMA type 162. In enterally fed children diagnosed mitochondrial disease gastric delay impairment was reported63.
Gastric decompression should be performed via nasogastric tube or gastrostomy tube. If it doesn’t resolve a jejunal tube placement or total parenteral nutrition can be considered to achieve feeding31. Small volume, frequent, low-fat and low fiber content feeding may be given in stable patients58. The gastric emptying is significantly faster with whey based formula compared to casein based formula64. The use of prokinetic drugs such as erythromycin, domperidone, cisapride and metoclopramide is contraversial because of their serious side effects and conflicting efficiacy58.