(381) Detection of Gastric Slow Waves Using High-Resolution Electrogastrogram in a Critically Ill Child

Introduction: Enteral nutrition (EN) is associated with lower mortality, shorter length of stay, and less organ dysfunction in critically ill children. Feeding intolerance, defined as the inability to tolerate adequate EN due to gastrointestinal (GI) symptoms, can result from altered gastric motility, mediated by slow-wave electrical activity produced by the interstitial cells of Cajal. Abnormal slow-wave activity can lead to gastric dysmotility. Limited tools exist to quantify gastric motility. High resolution electrogastrography (HR-EGG) uses a non-invasive electrode array to analyze spatiotemporal slow wave characteristics. Using this novel approach, we hypothesize that the presence of abnormal gastric signals in critically ill children will be associated with feeding intolerance.

Methods: A 14-year-old male patient with septic shock and multiorgan failure requiring veno-arterial extracorporeal membrane oxygenation with PIM-3 66% was enrolled. A 3x5 electrode array was applied to the abdomen and connected to an amplifier to obtain HR-EGG recordings prior to initiation of EN. A Second Order Blind Identification algorithm was used to identify gastric sources and reduce signal artifact from confounding HR-EGG signals. Mean dominant frequency (DF) and Percent Power Distribution [bradygastria < 2 cycles per minute (cpm), normogastria 2-4 cpm, tachygastria 4-9 cpm] were computed. Presence of GI symptoms was tracked via a Feeding Intolerance Score (FIS), which has been suggested as an independent predictor of mortality.

Results: HR-EGG data collected prior to initiation of EN showed gastric signals with mean DF 1.7 cpm and 43.8% bradygastria. In comparison, a healthy control 15-year-old male enrolled in a separate study had mean DF 2.5 cpm and 19% bradygastria. Our patient experienced mild abdominal distention, vomiting requiring gastric decompression, and loose stools when at 75% of goal EN and had a FIS of 7, indicating severe feeding intolerance.

Conclusions: Measurement of gastric slow-wave activity using HR-EGG appears feasible in critically ill children. These findings provide proof-of-concept that will inform a pilot study investigating a potential association between abnormal gastric slow-wave activity and elevated FIS. Future studies may demonstrate the ability of HR-EGG to predict feeding intolerance.