All right, welcome back to the Internet Book of Critical Care Podcast.

I'm here with Adam Thomas and we're going to take a slow trek through the elementary canal

and discuss gastroporesis, ilias, and colonic pseudo obstruction.

See what he did there, ladies and gentlemen?

A slow trip.

I love it, Josh. This is important because I have to say it takes up

a lot of time and cognitive space during rounds, doesn't it, Josh, the bowels. We got to get the

bowels moving. We have to make them human because they can't leave the department unless they're

eating and pooping and got the bad humors out, right? Yeah, this is a topic which it's not really flashy and I don't think it generally gets a lot

of attention, but it's something that's super important and I think if you don't pay attention

to it, it will eventually drag you and your patients down.

So let's start straight up with the largest organ up front, the stomach.

Critical illness-induced gastrop pieces, like you said, Josh, doesn't get the

limelight. But I have to say how many times do you hear the residuals are 500 or 600 or 800 or 200,

are 200? And you're trying to think about the fact that the vent FIO2 is 80. So maybe you don't

spend a lot of time on this, but I think it's important. Let's sit down, grab our coffee and think about what can cause gastroporesis. When do I need to be worried about

it and what to do about it? So start me off with the basics. What is this?

Yeah. So honestly, this is challenging when you try to read about gastropresis. Most of the

literature, most of the evidence is about kind of outpatient gastropriesis. And frankly, there's not a lot of data about this, you know, phenomenon of what I'm kind

of calling critical illness gastropresis, which is kind of where you take someone who's previously

healthy, they get on a ventilator, they're in the ICU, they're on opioids, and their stomach

basically stopped working.

...