DOI: https://doi.org/10.22141/2224-0586.1.88.2018.124970

Definitions and classifications of intestinal failure in adults

L.A. Maltseva, N.F. Mosentsev, V.I. Grishin, L.V. Kunik

Abstract


The aim of the article is to present definitions and classifications of intestinal failure (IF) in adults approved by the European Society for Clinical Nutrition and Metabolism (ESPEN). IF is defined as a decrease in bowel function below the minimum necessary to absorb macronutrients and/or water and electrolytes when an intravenous supplement is required to maintain health and/or growth. Functional classification based on the onset of the disease, metabolic and clinical outcome criteria identifies the IF as: type I — acute, transient and usually reversible; type II — prolonged acute condition, often in metabolic unstable patients, requiring a set of multidisciplinary measures and intravenous supplementation of nutrition for a period from weeks to months; type III — chronic condition in metabolically stable patients requiring intravenous supplementation for months or years; it can be reversible and irreversible. The pathophysiological classification distinguishes following states in IF that results from various gastrointestinal or systemic diseases: a “short loop” of the intestine; intestinal fistula, intestinal dyskinesia; mechanical obstruction; extensive disease of the intestinal mucosa; the primary and accompanying mechanisms of the listed diseases. Based on the energy and volume requirements of intravenous nutrition, 16 subtypes are distinguished in chronic IF. The characteristic of the IF degree evaluation according to the Lausanne Intestinal Failure Estimation (LIFE, 2008) is given based on the ideology of the Sequential Organ Failure Assessment (SOFA) model. The LIFE scale includes the calculation of clinical nutrition according to the ESPEN protocol, residual volume of the stomach, measurement of intra-abdominal pressure, determinations of constipation, diarrhea, peristalsis. It is necessary to evaluate both the entire scale of LIFE as a whole, as well as its individual components. As a general evaluation of the IF, the worst value should be chosen. Later, a combination of the presented LIFE model with the SOFA scale is possible.


Keywords


intestinal failure; European Society for Clinical Nutrition and Metabolism; Sequential Organ Failure Assessment; Lausanne Intestinal Failure Estimation

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