Hypermotility is a condition where the gastrointestinal tract moves too fast, causing symptoms such as diarrhea, abdominal pain, bloating, and malabsorption. Hypermotility can be caused by various factors, such as infections, medications, stress, or underlying diseases. In critically ill patients, hypermotility can lead to dehydration, electrolyte imbalance, malnutrition, and increased risk of infection. Treatment of hypermotility aims to reduce the frequency and severity of diarrhea, restore fluid and electrolyte balance, and correct nutritional deficiencies.
Feasibility/Equipment: Treatment of hypermotility can be administered by nurses or physicians in the intensive care unit (ICU), depending on the severity of the condition and the availability of resources. The treatment may include oral or intravenous medications, such as pancreatic enzymes, colestyramine, or loperamide; fluid and electrolyte replacement; enteral or parenteral nutrition; and probiotics or antibiotics if indicated. The equipment needed for the treatment may include syringes, infusion pumps, feeding tubes, catheters, and laboratory tests.
Scoring information: There is no specific scale or cut-off for diagnosing or monitoring hypermotility in critically ill patients. The diagnosis is based on clinical signs and symptoms, such as stool frequency, consistency, volume, and appearance; abdominal examination; and laboratory tests, such as stool culture, electrolytes, blood count, and inflammatory markers. The monitoring of hypermotility is based on the response to treatment, such as improvement in stool characteristics, hydration status, nutritional status, and infection control.
Cost: The cost of treatment of hypermotility in critically ill patients may vary depending on the type and duration of treatment, the availability of resources, and the local prices. Generally, oral medications are cheaper than intravenous medications; enteral nutrition is cheaper than parenteral nutrition.
Evidence: There is limited evidence for the treatment of hypermotility in critically ill patients from randomized controlled trials (RCTs) or systematic reviews. Most of the evidence comes from observational studies or case reports.
Accuracy / measurement properties: There is no specific outcome measure for assessing the accuracy or measurement properties of treatment of hypermotility in critically ill patients. The outcome measures may depend on the objectives and endpoints of each study or clinical practice.
References:
- Heyland DK, MacDonald S, Keefe L, Drover JW. Total parenteral nutrition in the critically ill patient: a meta-analysis. JAMA. 1998;280(23):2013-2019.
- Alhazzani W, Almasoud A, Jaeschke R, et al. Small bowel feeding and risk of pneumonia in adult critically ill patients: a systematic review and meta-analysis of randomized trials. Crit Care. 2013;17(4):R127.
- Casaer MP, Mesotten D, Hermans G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011;365(6):506-517.
- Reignier J, Boisramé-Helms J, Darmon M, et al. Early versus delayed parenteral nutrition in critically ill adults. N Engl J Med. 2020;382(21):1994-2005.
- Reintam Blaser A, Preiser JC, Fruhwald S, Wilmer A, Wernerman J, Benstoem C, Casaer MP, Starkopf J, van Zanten A, Rooyackers O, Jakob SM, Loudet CI, Bear DE, Elke G, Kott M, Lautenschläger I, Schäper J, Gunst J, Stoppe C, Nobile L, Fuhrmann V, Berger MM, Oudemans-van Straaten HM, Arabi YM, Deane AM; Working Group on Gastrointestinal Function within the Section of Metabolism, Endocrinology and Nutrition (MEN Section) of ESICM. Gastrointestinal dysfunction in the critically ill: a systematic scoping review and research agenda proposed by the Section of Metabolism, Endocrinology and Nutrition of the European Society of Intensive Care Medicine. Crit Care. 2020 May 15;24(1):224. doi: 10.1186/s13054-020-02889-4. PMID: 32414423; PMCID: PMC7226709.