• Reintam BlaserAnnikaADepartment of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia. annika.reintam.blaser@ut.ee.Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland. annika.reintam.blaser@ut.ee., Jean-Charles Preiser, Sonja Fruhwald, Alexander Wilmer, Jan Wernerman, Carina Benstoem, Michael P Casaer, Joel Starkopf, Arthur van Zanten, Olav Rooyackers, Stephan M Jakob, Cecilia I Loudet, Danielle E Bear, Gunnar Elke, Matthias Kott, Ingmar Lautenschläger, Jörn Schäper, Jan Gunst, Christian Stoppe, Leda Nobile, Valentin Fuhrmann, Mette M Berger, Oudemans-van StraatenHeleen MHMDepartment of Intensive Care, Amsterdam University Medical Center, VUMC, Amsterdam, The Netherlands., Yaseen M Arabi, Adam M Deane, and Working Group on Gastrointestinal Function within the Section of Metabolism, Endocrinology and Nutrition (MEN Section) of ESICM.
• Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia. annika.reintam.blaser@ut.ee.
• Crit Care. 2020 May 15; 24 (1): 224224.

BackgroundGastrointestinal (GI) dysfunction is frequent in the critically ill but can be overlooked as a result of the lack of standardization of the diagnostic and therapeutic approaches. We aimed to develop a research agenda for GI dysfunction for future research. We systematically reviewed the current knowledge on a broad range of subtopics from a specific viewpoint of GI dysfunction, highlighting the remaining areas of uncertainty and suggesting future studies.MethodsThis systematic scoping review and research agenda was conducted following successive steps: (1) identify clinically important subtopics within the field of GI function which warrant further research; (2) systematically review the literature for each subtopic using PubMed, CENTRAL and Cochrane Database of Systematic Reviews; (3) summarize evidence for each subtopic; (4) identify areas of uncertainty; (5) formulate and refine study proposals that address these subtopics; and (6) prioritize study proposals via sequential voting rounds.ResultsFive major themes were identified: (1) monitoring, (2) associations between GI function and outcome, (3) GI function and nutrition, (4) management of GI dysfunction and (5) pathophysiological mechanisms. Searches on 17 subtopics were performed and evidence summarized. Several areas of uncertainty were identified, six of them needing consensus process. Study proposals ranked among the first ten included: prevention and management of diarrhoea; management of upper and lower feeding intolerance, including indications for post-pyloric feeding and opioid antagonists; acute gastrointestinal injury grading as a bedside tool; the role of intra-abdominal hypertension in the development and monitoring of GI dysfunction and in the development of non-occlusive mesenteric ischaemia; and the effect of proton pump inhibitors on the microbiome in critical illness.ConclusionsCurrent evidence on GI dysfunction is scarce, partially due to the lack of precise definitions. The use of core sets of monitoring and outcomes are required to improve the consistency of future studies. We propose several areas for consensus process and outline future study projects.

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