A patient receiving mechanical ventilation is experiencing uncontrolled pain. How can associated gastrointestinal complications adversely influence this patient's time on the mechanical ventilator?

Question

A. O2 delivery may become impaired.
B. Bacterial translocation may increase.
C. Motility of the colon increases.
D. Airway obstruction may acutely develop.

Answer 1

?ANS: B
A. Incorrect response: See explanation B.
B. Correct response: Uncontrolled pain is known to produce complications of the gastrointestinal tract. Bowel motility is a function of the balance of sympathetic and parasympathetic tone. A result of increased sympathetic tone associated with stress responses is decreased gastric and colonic motility causing elevated gastric residual volumes, ileus, constipation, and nausea. As a consequence, the risk of aspiration results in suboptimal nutrition and increased bacterial translocation.
Bacterial translocation is the passage of viable indigenous bacteria from the intestinal tract through the epithelial mucosa to the mesenteric lymph nodes, and then to the systemic circulation. Infections, through translocation of intestinal bacteria, are a major cause of morbidity and mortality. Bacterial translocation is as a source of systemic infections and multiple system organ failure in critically ill patients. Various studies have shown that bacterial translocation can be caused by a breach of the mucosal barrier, impaired host immune defense mechanisms, and/or bacterial overgrowth, creating an ecologic imbalance in the indigenous intestinal microflora. The host's nutritional status influences these factors.
C. Incorrect response: Uncontrolled pain may produce decreased colonic motility.
D. Incorrect response: See explanation B.