GASTROINTESTINAL SYSTEM: Edited by Julia WendonManagement of gastrointestinal failure in the adult critical care settingBerger, Mette M.; Hurni, Claire-Anne Author Information Service of Adult Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland Correspondence to Mette M. Berger, MD, PhD, Service of Adult Intensive Care, Lausanne University Hospital, 1011 Lausanne, Switzerland. E-mail: [email protected] Current Opinion in Critical Care: April 2022 - Volume 28 - Issue 2 - p 190-197 doi: 10.1097/MCC.0000000000000924 Buy Metrics Abstract Purpose of review Gastrointestinal failure is a polymorphic syndrome with multiple causes. Managing the different situations from a practical, metabolic, and nutritional point of view is challenging, which the present review will try to address. Recent findings Acute gastrointestinal injury (AGI) has been defined and has evolved into a concept of gastrointestinal dysfunction score (GIDS) built on the model of Sequential Organ Failure Assessment (SOFA) score, and ranging from 0 (no risk) to 4 (life threatening). But there is yet no specific, reliable and reproducible, biomarker linked to it. Evaluating the risk with the Nutrition Risk Screening (NRS) score is the first step whenever addressing nutrition therapy. Depending on the severity of the gastrointestinal failure and its clinical manifestations, nutritional management needs to be individualized but always including prevention of undernutrition and dehydration, and administration of target essential micronutrients. The use of fibers in enteral feeding solutions has gained acceptance and is even recommended based on microbiome findings. Parenteral nutrition whether alone or combined to enteral feeding is indicated whenever the intestine is unable to process the needs. Summary The heterogeneity of gastrointestinal insufficiency precludes a uniform nutritional management of all critically ill patients but justifies its early detection and the implementation of individualized care. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.