Auscultation of bowel sounds in critical care: the role of the nurse

摘要

Gastrointestinal (GI) dysfunction is a common complication in critically ill patients and often results in longer intensive care unit (ICU) stays and high mortality rates (Reintam et al, 2006). Bowel sounds (BS) are a good indicator of GI motility and its auscultation could be an effective tool for nurses to assess and prevent GI dysfunction in critically ill patients (Baid, 2009). However, auscultation of BS has not received the level of attention that it deserves in critical care units. There have been many arguments for and against the usefulness of BS auscultation. Madsen et al (2005) argued that flatus, bowel movement, distension, nausea and vomiting are the most valued indicators of GI motility. However, because of health conditions specific to critically ill patients, including unconsciousness, haemodynamic instability, mechanical ventilation, and multiple organ dysfunction (Mutlu et al, 2001), nurses cannot obtain information on these indicators by normal communication with ICU patients, making them inapplicable in the critical care setting. Given this limitation, current practice in critically ill patients relies on indicators such as gastric tube drainage, tolerance of enteral feeding, gastric residual volumes, defecation and bowel sounds. Most of these indicators cannot be detected in patients without indwelling gastric tubes or enteral feeding. Additionally, the relationship between gastric tube drainage and GI motility is unclear. Deane et al (2007) stated that high gastric residual volume is not defined uniformly and exhibits only a weak correlation with gastric emptying. Khadaroo and Marshall (2008) argued that tolerance of enteral feeding is a subjective assessment and reflects a clinical decision to withhold feeding more than an intrinsic characteristic of the patient.