Gastric emptying measurement of liquid nutrients using the 13C-octanoate breath test in critically ill patients: A comparison with scintigraphy

Nam Q. Nguyen; Laura K. Bryant; Carly M. Burgstad; Marianne Chapman; Adam Deane; Max S. Bellon; Kylie Lange; Dylan Bartholomeuz; Michael Horowitz; Richard H. Holloway; Robert J L Fraser

doi:10.1007/s00134-013-2881-4

Gastric emptying measurement of liquid nutrients using the 13C-octanoate breath test in critically ill patients: A comparison with scintigraphy

Nam Q. Nguyen, Laura K. Bryant, Carly M. Burgstad, Marianne Chapman, Adam Deane, Max S. Bellon, Kylie Lange, Dylan Bartholomeuz, Michael Horowitz, Richard H. Holloway, Robert J L Fraser

Research output: Contribution to journal › Article › Research › peer-review

25 Citations (Scopus)

Abstract

Purpose: Scintigraphy is considered the most accurate technique for the measurement of gastric emptying (GE) but, for patients in the intensive care unit, it is technically demanding, involves radiation and can interfere with care. The ¹³C-octanoate breath test (¹³C-OBT) is a simple, non-invasive technique that does not involve radiation exposure. Aim: To evaluate the performance of the ¹³C-OBT in the assessment of GE in critically ill patients. Methods: The GE was assessed in 33 mechanically ventilated patients (23 M; 54.3 ± 3.0 yrs; APACHE II: 22.0 ± 1.1). Following test meal administration (100 ml Ensure®), concurrent scintigraphic measurement and breath samples (¹³C-OBT) were collected over 4 h. Scintigraphic meal retention was determined and the gastric emptying coefficient (GEC) and half emptying time [t50_(BT)] were calculated for the ¹³C-OBT. Delayed GE was defined as meal retention >13 % at 180 min. Results: Delayed GE was identified in 27/33 patients. Meal retention correlated modestly with t50_(BT) (r = 0.55-0.66; P < 0.001) and well with GEC (r = -0.63 to -0.74; P < 0.0001). The strength of agreement between the two techniques was highest between GEC and retention at 120 min. The best cut-off GEC for defining delayed GE was 3.25 (AUC = 0.75; 95 % CI = 0.52-0.99; P = 0.05), with 89 % sensitivity and 67 % specificity to detect delayed GE. The GE was delayed in all (23/23) patients with feed intolerance (GRV > 250 ml) on scintigraphy and 91 % (21/23) patients on ¹³C-OBT. Conclusion: In critical illness, there was a correlation between ¹³C-OBT and gastric scintigraphy, with GEC performing as a better and more sensitive marker of detecting delayed GE than t50. However the relatively wide 95 % confidence intervals suggest that ¹³C-OBT is more suitable as a technique to assess GE in a group setting for research studies rather than for individual patients in clinical practice.

Original language	English
Pages (from-to)	1238-1246
Number of pages	9
Journal	Intensive Care Medicine
Volume	39
Issue number	7
DOIs	https://doi.org/10.1007/s00134-013-2881-4
Publication status	Published - Jul 2013
Externally published	Yes

Keywords

C-octanoate breath test
Critical illness
Gastric emptying
Scintigraphy

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10.1007/s00134-013-2881-4

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Nguyen, N. Q., Bryant, L. K., Burgstad, C. M., Chapman, M., Deane, A., Bellon, M. S., Lange, K., Bartholomeuz, D., Horowitz, M., Holloway, R. H., & Fraser, R. J. L. (2013). Gastric emptying measurement of liquid nutrients using the 13C-octanoate breath test in critically ill patients: A comparison with scintigraphy. Intensive Care Medicine, 39(7), 1238-1246. https://doi.org/10.1007/s00134-013-2881-4

@article{16d559b2d58541df9f3bf676f8362d2b,

title = "Gastric emptying measurement of liquid nutrients using the 13C-octanoate breath test in critically ill patients: A comparison with scintigraphy",

abstract = "Purpose: Scintigraphy is considered the most accurate technique for the measurement of gastric emptying (GE) but, for patients in the intensive care unit, it is technically demanding, involves radiation and can interfere with care. The 13C-octanoate breath test (13C-OBT) is a simple, non-invasive technique that does not involve radiation exposure. Aim: To evaluate the performance of the 13C-OBT in the assessment of GE in critically ill patients. Methods: The GE was assessed in 33 mechanically ventilated patients (23 M; 54.3 ± 3.0 yrs; APACHE II: 22.0 ± 1.1). Following test meal administration (100 ml Ensure{\textregistered}), concurrent scintigraphic measurement and breath samples (13C-OBT) were collected over 4 h. Scintigraphic meal retention was determined and the gastric emptying coefficient (GEC) and half emptying time [t50(BT)] were calculated for the 13C-OBT. Delayed GE was defined as meal retention >13 % at 180 min. Results: Delayed GE was identified in 27/33 patients. Meal retention correlated modestly with t50(BT) (r = 0.55-0.66; P < 0.001) and well with GEC (r = -0.63 to -0.74; P < 0.0001). The strength of agreement between the two techniques was highest between GEC and retention at 120 min. The best cut-off GEC for defining delayed GE was 3.25 (AUC = 0.75; 95 % CI = 0.52-0.99; P = 0.05), with 89 % sensitivity and 67 % specificity to detect delayed GE. The GE was delayed in all (23/23) patients with feed intolerance (GRV > 250 ml) on scintigraphy and 91 % (21/23) patients on 13C-OBT. Conclusion: In critical illness, there was a correlation between 13C-OBT and gastric scintigraphy, with GEC performing as a better and more sensitive marker of detecting delayed GE than t50. However the relatively wide 95 % confidence intervals suggest that 13C-OBT is more suitable as a technique to assess GE in a group setting for research studies rather than for individual patients in clinical practice.",

keywords = "C-octanoate breath test, Critical illness, Gastric emptying, Scintigraphy",

author = "Nguyen, {Nam Q.} and Bryant, {Laura K.} and Burgstad, {Carly M.} and Marianne Chapman and Adam Deane and Bellon, {Max S.} and Kylie Lange and Dylan Bartholomeuz and Michael Horowitz and Holloway, {Richard H.} and Fraser, {Robert J L}",

year = "2013",

month = jul,

doi = "10.1007/s00134-013-2881-4",

language = "English",

volume = "39",

pages = "1238--1246",

journal = "Intensive Care Medicine",

issn = "0342-4642",

publisher = "Springer-Verlag London Ltd.",

number = "7",

}

Nguyen, NQ, Bryant, LK, Burgstad, CM, Chapman, M, Deane, A, Bellon, MS, Lange, K, Bartholomeuz, D, Horowitz, M, Holloway, RH & Fraser, RJL 2013, 'Gastric emptying measurement of liquid nutrients using the 13C-octanoate breath test in critically ill patients: A comparison with scintigraphy', Intensive Care Medicine, vol. 39, no. 7, pp. 1238-1246. https://doi.org/10.1007/s00134-013-2881-4

TY - JOUR

T1 - Gastric emptying measurement of liquid nutrients using the 13C-octanoate breath test in critically ill patients

T2 - A comparison with scintigraphy

AU - Nguyen, Nam Q.

AU - Bryant, Laura K.

AU - Burgstad, Carly M.

AU - Chapman, Marianne

AU - Deane, Adam

AU - Bellon, Max S.

AU - Lange, Kylie

AU - Bartholomeuz, Dylan

AU - Horowitz, Michael

AU - Holloway, Richard H.

AU - Fraser, Robert J L

PY - 2013/7

Y1 - 2013/7

N2 - Purpose: Scintigraphy is considered the most accurate technique for the measurement of gastric emptying (GE) but, for patients in the intensive care unit, it is technically demanding, involves radiation and can interfere with care. The 13C-octanoate breath test (13C-OBT) is a simple, non-invasive technique that does not involve radiation exposure. Aim: To evaluate the performance of the 13C-OBT in the assessment of GE in critically ill patients. Methods: The GE was assessed in 33 mechanically ventilated patients (23 M; 54.3 ± 3.0 yrs; APACHE II: 22.0 ± 1.1). Following test meal administration (100 ml Ensure®), concurrent scintigraphic measurement and breath samples (13C-OBT) were collected over 4 h. Scintigraphic meal retention was determined and the gastric emptying coefficient (GEC) and half emptying time [t50(BT)] were calculated for the 13C-OBT. Delayed GE was defined as meal retention >13 % at 180 min. Results: Delayed GE was identified in 27/33 patients. Meal retention correlated modestly with t50(BT) (r = 0.55-0.66; P < 0.001) and well with GEC (r = -0.63 to -0.74; P < 0.0001). The strength of agreement between the two techniques was highest between GEC and retention at 120 min. The best cut-off GEC for defining delayed GE was 3.25 (AUC = 0.75; 95 % CI = 0.52-0.99; P = 0.05), with 89 % sensitivity and 67 % specificity to detect delayed GE. The GE was delayed in all (23/23) patients with feed intolerance (GRV > 250 ml) on scintigraphy and 91 % (21/23) patients on 13C-OBT. Conclusion: In critical illness, there was a correlation between 13C-OBT and gastric scintigraphy, with GEC performing as a better and more sensitive marker of detecting delayed GE than t50. However the relatively wide 95 % confidence intervals suggest that 13C-OBT is more suitable as a technique to assess GE in a group setting for research studies rather than for individual patients in clinical practice.

AB - Purpose: Scintigraphy is considered the most accurate technique for the measurement of gastric emptying (GE) but, for patients in the intensive care unit, it is technically demanding, involves radiation and can interfere with care. The 13C-octanoate breath test (13C-OBT) is a simple, non-invasive technique that does not involve radiation exposure. Aim: To evaluate the performance of the 13C-OBT in the assessment of GE in critically ill patients. Methods: The GE was assessed in 33 mechanically ventilated patients (23 M; 54.3 ± 3.0 yrs; APACHE II: 22.0 ± 1.1). Following test meal administration (100 ml Ensure®), concurrent scintigraphic measurement and breath samples (13C-OBT) were collected over 4 h. Scintigraphic meal retention was determined and the gastric emptying coefficient (GEC) and half emptying time [t50(BT)] were calculated for the 13C-OBT. Delayed GE was defined as meal retention >13 % at 180 min. Results: Delayed GE was identified in 27/33 patients. Meal retention correlated modestly with t50(BT) (r = 0.55-0.66; P < 0.001) and well with GEC (r = -0.63 to -0.74; P < 0.0001). The strength of agreement between the two techniques was highest between GEC and retention at 120 min. The best cut-off GEC for defining delayed GE was 3.25 (AUC = 0.75; 95 % CI = 0.52-0.99; P = 0.05), with 89 % sensitivity and 67 % specificity to detect delayed GE. The GE was delayed in all (23/23) patients with feed intolerance (GRV > 250 ml) on scintigraphy and 91 % (21/23) patients on 13C-OBT. Conclusion: In critical illness, there was a correlation between 13C-OBT and gastric scintigraphy, with GEC performing as a better and more sensitive marker of detecting delayed GE than t50. However the relatively wide 95 % confidence intervals suggest that 13C-OBT is more suitable as a technique to assess GE in a group setting for research studies rather than for individual patients in clinical practice.

KW - C-octanoate breath test

KW - Critical illness

KW - Gastric emptying

KW - Scintigraphy

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U2 - 10.1007/s00134-013-2881-4

DO - 10.1007/s00134-013-2881-4

M3 - Article

C2 - 23471513

AN - SCOPUS:84879119732

VL - 39

SP - 1238

EP - 1246

JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

IS - 7

ER -

Gastric emptying measurement of liquid nutrients using the 13C-octanoate breath test in critically ill patients: A comparison with scintigraphy

Abstract

Keywords

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Measurement of gastric emptying in the critically ill

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