A clinical approach to acute mesenteric ischemia. Issue 2 (April 2021)

• Record Type: Journal Article
• Authors: Reintam Blaser, Annika; Acosta, Stefan; Arabi, Yaseen M.
• Is Part Of: Current opinion in critical care. Volume 27:Issue 2(2021)
• Publication Date: 2021-04
• Subjects: acute mesenteric ischemia -- computed tomography -- critical care -- nonocclusive; Critical care medicine -- Periodicals; 616.028
• DOI: 10.1097/MCC.0000000000000802
• Languages: English
• ISSNs: 1070-5295

Abstract

Abstract : Purpose of review: To summarize current evidence on acute mesenteric ischemia (AMI) in critically ill patients, addressing pathophysiology, definition, diagnosis and management. Recent findings: A few recent studies showed that a multidiscipliary approach in specialized centers can improve the outcome of AMI. Such approach incorporates current knowledge in pathophysiology, early diagnosis with triphasic computed tomography (CT)-angiography, immediate endovascular or surgical restoration of mesenteric perfusion, and damage control surgery if transmural bowel infarction is present. No specific biomarkers are available to detect early mucosal injury in clinical setting. Nonocclusive mesenteric ischemia presents particular challenges, as the diagnosis based on CT-findings as well as vascular management is more difficult; some recent evidence suggests a possible role of potentially treatable stenosis of superior mesenteric artery and beneficial effect of vasodilator therapy (intravenous or local intra-arterial). Medical management of AMI is supportive, including aiming of euvolemia and balanced systemic oxygen demand/delivery. Enteral nutrition should be withheld during ongoing ischemia-reperfusion injury and be started at low rate after revascularization of the (remaining) bowel is convincingly achieved. Summary: Clinical suspicion leading to tri-phasic CT-angiography is a mainstay for diagnosis. Diagnosis of nonocclusive mesenteric ischemia and early intestinal injury remains challenging. Multidisciplinary team effort may improve the outcome of AMI.