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13CO2 breath tests, a tool to assess intestinal and liver function in the ICU?

Vogt, Josef A; Radermacher, Peter; Georgieff, Michael

Current Opinion in Critical Care: April 2010 - Volume 16 - Issue 2 - p 169–175
doi: 10.1097/MCC.0b013e3283376739
Gastrointestinal system: Edited by Peter Radermacher

Purpose of review 13CO2 breath tests, based on nondispersive infrared (NDIR) measurement technology, offer the chance for a noninvasive online quantitation of physiological processes. With recent extensions of the NDIR measurement technology breath tests could be used in an ICU setting without any restriction. Since online tools to assess feed intolerance with gastric emptying and to quantify gradual changes in liver function are still missing, this review explores the potential of breath tests to fill this gap.

Recent findings Gastric emptying may be correctly quantified; however, the corresponding tests fail to capture aberrations in nutrient absorption, which appear to be linked to hyperglycemia and insulin resistance and may contribute to feed intolerance. The progression or ameloriation of liver injury could be assessed with breath tests, which cannot, however, distinguish between functional and macrocirculatory or microcirculatory disorders.

Summary Breath tests for liver function and gastric emptying taken alone may fail in their ability to specifically quantify the clinical disorders. However, invasive test extensions could help to characterize their validity and thus to identify additional, noninvasive measurements to assure and expand this domain.

Klinik für Anästhesiologie, Universitätsklinikum, Ulm, Germany

Correspondence to Josef A. Vogt, PhD, Sektion Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Klinik für Anästhesiologie, Universitätsklinikum, Parkstrasse 11, D-89073 Ulm, Germany Tel: +49 731 500 60160; fax: +49 731 500 60162; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.