Patients in the intensive care unit (ICU) are often at risk of gastrointestinal dysfunction and malnutrition. Gastrointestinal dysfunction was associated with poor clinical outcomes, including prolonged mechanical ventilation, prolonged ICU stay and increased 90-day mortality. There have been some clinical studies investigating the effects of traditional Chinese acupoint massage, acupuncture, or moxibustion of 7 acupoints (Zhongwan Point (CV12), Tianshu Point (ST25), Qihai Point (CV6), Zusanli point (ST36), Shangjuxu Point (ST37), Neiguan Point (PC6) and Hegu Point (LI4)) on gastrointestinal function recovery. Gastrointestinal dysfunction could be improved by stimulating single acupoint or combining multiple acupoints, and the effects of combined stimulation of multiple acupoints was better for the improvement of gastrointestinal dysfunction. This project aims to study the effects of traditional Chinese acupoint massage, acupuncture, or moxibustion of 7 acupoints (Zhongwan Point (CV12), Tianshu Point (ST25), Qihai Point (CV6), Zusanli point (ST36), Shangjuxu Point (ST37), Neiguan Point (PC6) and Hegu Point (LI4)) on the 28-day survival, and the gastrointestinal function recovery in critically ill patients with with gastrointestinal dysfunction caused by medical diseases and critically ill patients with high risk of malnutrition in ICU, and to observe their effects on the recovery of gastrointestinal barrier function by measuring the serum intestinal fatty acid binding protein (iFABP), citrulline, diamine oxidase (DAO) and D-lactic acid. Studies have shown that serum iFABP, citrulline, DAO and D-lactic acid could reflect the intestinal barrier function of the patients.
Study Type
OBSERVATIONAL
Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
Wuhan, Hubei, China
28-day survival rate (%)
Survival at 28 days after hospitalization
Time frame: Up to 4 weeks
Ultrasound assessment of gastrointestinal function: ACF (times/min)
Antral contraction frequency (ACF): In semi-recumbent position at 45°, infuse the stomach with 300ml of warm water. Within 6 minutes after infusion, divide the number of antral contractions by 3.
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Ultrasound assessment of gastrointestinal function: ACA (%)
Antral contraction amplitude (ACA): Measure the area during 3 maximum relaxations (S relaxation) and minimum contractions (S contraction), calculate the change in antral area (ΔS = S relaxation - S contraction), and take the average of 3 measurements. Antral contraction amplitude: ΔS/S relaxation.
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Ultrasound assessment of gastrointestinal function: MI
Motility index (MI): ACF × ACA.
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Ultrasound assessment of gastrointestinal function: GET (min)
Gastric emptying time (GET): In semi-recumbent position at 45°, infuse the stomach with 300ml of warm water. Use the maximum antral relaxation as the standard and measure the area every 5 minutes until the liquid in the antrum is emptied. The time it takes for the gastric antrum to empty is GET.
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Ultrasound assessment of gastrointestinal function: intestinal wall thickness (mm)
Intestinal wall thickness of Jejunum/Ileum/Colon: Refers to the distance between the serosal and mucosal surfaces of the intestinal wall. The normal thickness of the small intestine is 2-3mm, and \>3mm may indicate thickening of the intestinal wall; the thickness of the colon wall is approximately 3-4mm, and \>5mm may suggest thickening of the intestinal wall. Attention should be paid to the colon pocket and the plica structure on the colon wall.
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Ultrasound assessment of gastrointestinal function: intestinal diameter (cm)
Intestinal diameter of Jejunum/Ileum/Colon: When not under pressure, the measurement of the width of the small intestine often refers to the distance between the mucosal surfaces of the intestinal wall. The intestinal lumen width of the small intestine (jejunum/ileum) is generally \<2cm, and \>3cm may indicate intestinal dilation; the internal diameter of the colon is generally \<5cm.
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Ultrasound assessment of gastrointestinal function: intestinal motility
Intestinal motility of Jejunum/Ileum/Colon (yes or no): Under normal circumstances, intestinal movement can be clearly judged at the ultrasound interface. When the intestine is filled with gas or accompanied by intestinal dilation, intestinal motility can be judged by the "creeping gas sign" of the gas or the movement of the contents. In addition, attention should be paid to the intestinal motility caused by the pressure on the intestinal tube when moving the probe.
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Daily amount of enteral nutrition feeding (ml)
Daily amount of enteral nutrition feeding
Time frame: Within 5 days after study inclusion
Daily gastric residual volume (ml)
Daily gastric residual volume
Time frame: Within 5 days after study inclusion
Serum levels of intestinal fatty acid binding protein (iFABP, ng/ml)
Serum levels of iFABP measured by ELISA.
Time frame: 0, 72 and 120 hours after study inclusion
Serum levels of citrulline (μmol/L)
Serum levels of citrulline measured by ELISA.
Time frame: 0, 72 and 120 hours after study inclusion
Serum levels of diamine oxidase (DAO, U/L)
Serum levels of DAO measured by ELISA.
Time frame: 0, 72 and 120 hours after study inclusion
Serum levels of D-lactic acid (mmol/L)
Serum levels of D-lactic acid measured by ELISA.
Time frame: 0, 72 and 120 hours after study inclusion
Superior mesenteric artery resistance index
Superior mesenteric artery resistance index evaluated by ultrasound
Time frame: 0, 72 and 120 hours after study inclusion
Intra-abdominal pressure (IAP) (mmHg)
Intra-abdominal pressure (IAP)
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Diarrhea
Yes (numbers) or No
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
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Alimentary tract hemorrhage
Yes (numbers) or No
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Prealbumin concentration (g/L)
Serum levels of prealbumin
Time frame: 0, 72 and 120 hours after study inclusion
Acute physiology and chronic health evaluation (APACHE) Ⅱ score
0-67, higher scores correspond to more severe disease and a higher risk of death
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
ICU length of stay (days)
ICU length of stay
Time frame: Up to 4 weeks
In-hospital mortality (%)
Mortality rate during hospitalization
Time frame: Up to 4 weeks
Peripheral venous blood CRP concentration (mg/L)
CRP level measured by blood routine examination
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Peripheral venous blood hemoglobin concentration (g/L)
Hemoglobin level measured by blood routine examination
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Absolute number of white blood cells in the peripheral venous blood (number/L)
Absolute number of white blood cells measured by blood routine examination
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Absolute number of platelets in the peripheral venous blood (number/L)
Absolute number of platelets measured by blood routine examination
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Absolute number of lymphocytes in the peripheral venous blood (number/L)
Absolute number of lymphocytes measured by blood routine examination
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Whole blood pH
Arterial pH measured by blood gas analysis
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Arterial PaO2 (mmHg)
Arterial PaO2 measured by blood gas analysis
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Arterial PaCO2 (mmHg)
Arterial PaCO2 measured by blood gas analysis
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Arterial bicarbonate (mmol/L)
Arterial bicarbonate measured by blood gas analysis
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Arterial lactic acid (mmol/L)
Arterial lactic acid measured by blood gas analysis
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Peripheral venous blood albumin concentration (g/L)
Albumin level measured by Blood biochemical examination
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Peripheral venous blood total bilirubin concentration (μmol/L)
Total bilirubin level measured by Blood biochemical examination
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Peripheral venous blood bound bilirubin concentration (μmol/L)
Bound bilirubin level measured by Blood biochemical examination
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Peripheral venous blood creatinine concentration (μmol/L)
Creatinine level measured by Blood biochemical examination
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Peripheral venous blood ALT concentration (U/L)
ALT level measured by Blood biochemical examination
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion
Peripheral venous blood AST concentration (U/L)
AST level measured by Blood biochemical examination
Time frame: 0, 24, 48, 72, 96 and 120 hours after study inclusion