Journal of Pediatric Critical Care

P - ISSN : 2349-6592    |    E - ISSN : 2455-7099

Symposium Guest Editorial
Year : 2016 | Volume : 3 | Issue : 4 | Page : 35-36

Getting Critical about Gastrointestinal and liver Issues in PICU

Dr Maninder Dhaliwal*,Dr Praveen Khilnani**

*Senior Consultant, Pediatric Intensive Care unit, ICU 5, Medanta, the Medicity, Gurgaon
**Head PICU Mediclinic City Hospital Dubai Health Care City and PICU Fellowship Program BLK Superspeciality Hospital, New Delhi

Correspondence Address:

Maninder Singh Dhaliwal
Senior Consultant, Pediatric Intensive Care unit, ICU 5, Medanta, the Medicity, Gurgaon – 122001, Phone number +91-9999669415, email id: docmsdhaliwal@gmail.com
Received: 28-Oct-16/Accepted: 07-Nov-16/Published online: 22-Nov-16

Source of Funding:None Conflict of Interest:None

DOI:10.21304/2016.0304.00143


Abdominal issues are commonly seen in pediatric critical care, both as a primary reason for admission or as a part of multiple organ dysfunction syndromes during the course of a pediatric intensive care unit (PICU) stay. Dramatic advances have been made in critical care over the years with focus on various aspects of lung injury, hemodynamics in shock; kidney injury etc but gastrointestinal problems have not really received similar attention. It is only recently that the Working Group on Abdominal Problems (WGAP) as part of the Perioperative Intensive Care (POIC) section of the European Society of Intensive Care Dr Maninder Dhaliwal Maninder Singh Dhaliwal, Senior Consultant, Pediatric Intensive Care unit, ICU 5, Medanta, the Medicity, Gurgaon Dr Praveen Khilnani HOD PICU Mediclinic city hospital Dubai Health care city, Director, Pediatric Intensive Care Unit , PICU fellowship BLK Superspeciality,NewDelhi photo Medicine (ESICM) have proposed the expression of term ‘‘acute gastrointestinal injury injury’’(AGI)1.

‘‘GI dysfunction’’ is the term generally used to describe the large variety of GI symptoms (diarrhea, vomiting) and diagnoses (gastroenteritis) outside of the ICU setting. Now the term AGI has been proposed for ICU settings with four grades of severity. AGI grade I stands for a self-limiting condition with increased risk of developing GI dysfunction or failure; AGI grade II is a condition requiring interventions to restore GI function; AGI grade III (GI failure) is a condition when GI function cannot be restored with interventions; and AGI grade IV is dramatically manifesting GI failure, which poses imminent life-threatening risk.

The gastrointestinal system comprises of four broad components: the intestinal epithelium, the mucosal immune system, the enteric nervous system, and the commensal microflora of the gut lumen. Functional failure can occur at any level of gut physiology, and the impact can be confined to a particular region or the entire organ. Irrespective, majority of critically ill patients have at least one gastrointestinal symptom during their ICU stay and this GI injury usually affects daily PICU management. This critical illness-associated GI injury is implicated in the physiological processes that drive critical illness, and is further linked to negative nutritional and infectious consequences and subsequently poorer clinical outcomes. Many of the commonly occurring gastrointestinal problems in critically sick children (e.g. feeding intolerance, absent/abnormal bowel sounds, diarrhea, distension, ileus) are vaguely addressed in literature. An attempt is being made to define and discuss the same in this unique symposium. Upper GI bleeding is always a challenge in PICU settings which has been addressed as a separate review, highlighting step wise approach to the same. Two review articles from an intensivist perspective on acute liver failure and acute severe pancreatitis management are part of this symposium. The article on Acute liver failure(ALF) highlights the newer management protocols in ALF in children, with stress on metabolic liver disease and tough transplant decision making; both for the family and intensivist. The article on pancreatitis highlights the newer pediatric definition, pediatric prognostic scores and the most recent management protocol which highlights aggressive early fluid resuscitation and early enteral nutrition. And last but not the least, intraabdominal pressure monitoring, an adjuvant tool useful in abdominal assessment in PICU has also been described in this symposium. This article stresses on early recognition of intra abdominal hypertension and abdominal compartment syndrome in PICU. This symposium is a combined effort of gastroenterologist and intensivist, with an idea to address common GI issues in PICU and outline management strategies.

Reference:
1. Reintam Blaser A, Malbrain ML, Starkopf J, et al. Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Med 2012; 38:384-394