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Enteral feeding intolerance (EFI) is a common feature in critically ill patients worldwide. However, there is no clear, widely agreed-upon definition available, with various studies rarely using the same definition. The term EFI is frequently used to describe vomiting or large gastric residual volumes associated with enteral feeding as a result of gastroparesis/delayed gastric emptying. However, the syndrome of EFI may represent the consequence of various pathophysiological mechanisms, and this heterogeneity may explain varying associations with outcomes. In clinical practice, a pragmatic definition may be useful. A pragmatic definition of EFI is that a clinician has decided to reduce the amount of enteral nutrition specifically because features of gastrointestinal dysfunction appeared during enteral feeding. For research purposes, a more detailed definition of EFI is required to improve knowledge and explore interventions that may improve patient-centered outcomes. The objective of this review is to summarize available evidence on existing definitions, pathophysiological mechanisms, and the clinical relevance of EFI in critically ill patients. Based on current knowledge, we propose a conceptual framework for a definition of EFI for a future consensus process.

Gastrointestinal dysmotility causes delayed gastric emptying, enteral feed intolerance, and functional obstruction of the small and large intestine, the latter functional obstructions being frequently termed ileus and Ogilvie syndrome, respectively. In addition to meticulous supportive care, drug therapy may be appropriate in certain situations. There is, however, considerable variation among individuals regarding what gastric residual volume identifies gastric dysmotility and would encourage use of a promotility drug. While the administration of either metoclopramide or erythromycin is supported by evidence it appears that, dual-drug therapy (erythromycin and metoclopramide) reduces the rate of treatment failure. There is a lack of evidence to guide drug therapy of ileus, but neither erythromycin nor metoclopramide appear to have a role. Several drugs, including ghrelin agonists, highly selective 5-hydroxytryptamine receptor agonists, and opiate antagonists are being studied in clinical trials. Neostigmine, when infused at a relatively slow rate in patients receiving continuous hemodynamic monitoring, may alleviate the need for endoscopic decompression in some patients.

Clinicians and researchers frequently use the phrase 'feeding intolerance' (FI) as a descriptive term in enterally fed critically ill patients. We aimed to: (1) determine what is the most accepted definition of FI; (2) estimate the prevalence of FI; and (3) evaluate whether FI is associated with important outcomes. Systematic searches of peer-reviewed publications using PubMed, MEDLINE, and Web of Science were performed with studies reporting FI extracted. We identified 72 studies defining FI. In 33 studies, the definition was based on large gastric residual volumes (GRVs) together with other gastrointestinal symptoms, while 30 studies relied solely on large GRVs, six studies used inadequate delivery of enteral nutrition (EN) as a threshold, and three studies gastrointestinal symptoms without reference to GRV. The median volume used to define a 'large' GRV was 250 ml (ranges from 75 to 500 ml). The pooled proportion (n = 31 studies) of FI was 38.3% (95% CI 30.7-46.2). Five studies reported outcomes, all of them observed adverse outcome in FI patients. In three studies, respectively, FI was associated with increased mortality and ICU length-of-stay. In summary, FI is inconsistently defined but appears to occur frequently. There are preliminary data indicating that FI is associated with adverse outcomes. A standard definition of FI is required to determine the accuracy of these preliminary data.

Background: Intra-abdominal hypertension (IAH) in intensive care patients is associated with an adverse outcome, but the risk factors for development of IAH have not been extensively studied. We aimed to identify independent risk factors for IAH in mechanically ventilated (MV) patients. Methods: In this prospective observational study, 563 MV patients staying in the general intensive care unit (ICU) of a university hospital for more than 24 h were observed during their ICU stay. Repeated intermittent measurements of intra-abdominal pressure (IAP) via the urinary bladder were performed. Results: IAH (sustained or repeated IAP≥12 mmHg) developed in 182 patients (32.3%). From all the study patients, 44.4% had a primary pathology in the abdomino-pelvic region. Two thirds of all IAH cases developed in this group. Obesity [body mass index (BMI)>30], high positive end-expiratory pressure (PEEP>10), respiratory failure (PaO2/FiO2 30, PEEP>10 cmH2O, PaO2/FiO2

Background: Gastrointestinal (GI) problems are not uniformly assessed in intensive care unit (ICU) patients and respective data in available literature are insufficient. We aimed to describe the prevalence, risk factors and importance of different GI symptoms. Methods: We prospectively studied all patients hospitalized to the General ICU of Tartu University Hospital in 2004–2007. Results: Of 1374 patients, 62 were excluded due to missing data. Seven hundred and seventy-five (59.1%) patients had at least one GI symptom at least during 1 day of their stay, while 475 (36.2%) suffered from more than one symptom. Absent or abnormal bowel sounds were documented in 542 patients (41.3%), vomiting/regurgitation in 501 (38.2%), high gastric aspirate volume in 298 (22.7%), diarrhoea in 184 (14.0%), bowel distension in 139 (10.6%) and GI bleeding in 97 (7.4%) patients during their ICU stay. Absent or abnormal bowel sounds and GI bleeding were associated with significantly higher mortality. The number of simultaneous GI symptoms was an independent risk factor for ICU mortality. The ICU length of stay and mortality of patients who had two or more GI symptoms simultaneously were significantly higher than in patients with a maximum of one GI symptom. Conclusion: GI symptoms occur frequently in ICU patients. Absence of bowel sounds and GI bleeding are associated with impaired outcome. Prevalence of GI symptoms at the first day in ICU predicts the mortality of the patients.

A soil map at the scale 1:10,000 serves as a major important document for land owners and local governments, which allows them to use soil information in their daily activity. The intensity of exploitation of soil maps will increase when the very map and its legend are supplemented, within colored and indexed polygons, with information about soil texture and reaction by layers, but also about the thickness and characterization of the epipedon, quality indices for soil assessment, classes of stoniness, and prevalent fractions of stones, erosion risk, etc. Special maps of agronomical status, with a list of proper measures for improvement of soils and their associations, should form a regular component of large-scale mapping. As decrease in arable land and increase in the forest area are common trends in land use, these maps and general soil data should serve as the fundamental source of information for decision making concerning land use. Data indicating the suitability of any soil for any crop should be entered in a database. Application of GIS on any level of national economy, digitization of a large-scale soil database and making it accessible to land users would allow to expand the amount of available information for each soil map polygon. Grosmasstabige Bodenkarten und erganzende Datenbank zur Landnutzungsplanung in Estland Die Bodenkarte im Masstab 1:10000 dient den Landbesitzern und kommunalen Verwaltungen als eine wesentliche Unterlage fur ihre tagliche Arbeit sowohl auf dem Feld als auch im Hinblick auf die Bearbeitungsplanung. Die Anwendung von Informationen aus Bodenkarten erfordert die Einbeziehung von zusatzlichen Angaben, z.B. uber die Bodenart und -reaktion (nach Horizonten), uber die Machtigkeit und die Eigenschaften des Epipedons, uber die Bodenbewertung, uber Steingehalte und -grosenklassen, Erosionsrisiken etc. in Form von kolorierten und indexierten Polygonen. Spezialkarten zur Landnutzung mit einer Liste der empfohlenen Masnahmen zur Verbesserung des Bodenzustandes sollten in die grosmasstabigen Karten eingearbeitet werden. Da die Verringerung der landwirtschaftlichen Nutzflachen bei gleichzeitiger Zunahme der Waldflachen eine allgemeine Tendenz ist, sollten diese Karten und ausfuhrliche Bodendaten eine Grundlage fur Entscheidungsfindung im Bereich der Landnutzung darstellen. Angaben uber die fur jeden Boden geeigneten Pflanzen sollten in einer Datenbank gespeichert sein. Durch den Einsatz von GIS-Systemen in verschiedenen Wirtschaftsbereichen, durch die Digitalisierung der grosmasstabigen Bodendatenbank und ihre Zuganglichkeit fur Landnutzer kann die Datenmenge fur jedes Polygon der Bodenkarte deutlich verbessert werden.

Mouse N1E-115 neuroblastoma cells were used to study carbachol induced changes in muscarinic cholinergic parameters. Cells were treated with carbachol (1 mM) for up to 96 hours. The number of muscarinic receptors, measured in 3H-3-quinuclidinyl benzilate binding experiments, decreased approximately 50% after 4 hours exposure to carbachol. This was followed by an increase in binding sites, and after 24 hours the number of binding sites was the same as in control cells. The changes observed in the choline esterase activity followed the same pattern. The increase in number of binding sites was not dependent on protein synthesis, while the increase in choline esterase activity was. The muscarinic receptor-stimulated uptake of 45Ca2+ showed an initial decrease, which was followed by a significantly increased basal uptake of 45Ca2+. It is suggested that all these changes are adaptations of long time exposure to carbachol.