Berger et al reported the Lausanne Intestinal Failure Estimation (LIFE) score for evaluating a patient in the intensive care unit (ICU). The authros are from Centre HospitalierUniversitaire Vaudois in Lausanne.
Patient selection: critically ill patient
Parameters:
(1) intra-abdominal hypertension (IAH) in mm Hg
(2) serum lactate in mmol/L with pH < 7.25
(3) gastric residue in mL
(4) progression of feed by day of enteral nutrition
(5) bowel movements
(6) diarrhea (defined as liquid stools occurring >= 4 times per day)
(7) bowel sounds
|
Parameter |
Finding |
Points |
|
IAH |
< 12 mm Hg |
0 |
|
|
12 to 14.99 mm Hg |
1 |
|
|
15 to 19.99 mm Hg |
2 |
|
|
20 to 25 mm Hg |
3 |
|
|
> 25 mm Hg |
4 |
|
serum lactate |
< 2 mmol/L |
0 |
|
|
2 to 2.99 mmol/L |
1 |
|
|
3 to 3.99 mmol/L |
2 |
|
|
4 to 5 mmol/L |
3 |
|
|
> 5 mmol/L |
4 |
|
gastric residue |
< 200 mL |
0 |
|
|
200 to 300 mL |
1 |
|
|
301 to 400 mL |
2 |
|
|
> 400 mL |
3 |
|
progression of feed |
normal |
0 |
|
|
< 60% of needs by day 3 |
2 |
|
|
< 60% of target by day 4 |
4 |
|
constipation |
1 stool per 1-3 days |
0 |
|
|
0 in 4 days |
1 |
|
|
0 in 5 days with bloating |
2 |
|
|
abdominal distention |
3 |
|
|
Ogilvie syndrome |
4 |
|
liquid stools per day |
< 4 |
0 |
|
|
4 to 6 |
2 |
|
|
7 to 10 |
3 |
|
|
> 10 |
4 |
|
bowel sounds |
normal |
0 |
|
|
silence |
1 |
|
|
tympanic |
3 |
where:
• Some of the entries in Table 1 overlap at breakpoints or leave gaps. The above table is an attempt to deal with these.
• Constipation and diarrhea would seem to be mutually exclusive,
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 22 (since constipation and diarrhea do not co-exist)
• The higher the score the more severe the gastrointestinal dysfunction.
Specialty: Critical Care, Pulmonology
