AM Deane

CE Cousins

KL Jones

M Horowitz

MJ Chapman

MP Plummer

P Kar

T Hausken

Intensive Care Medicine Experimental

PubMed

Crossref

POSTER PRESENTATION Open AccessNutrient-stimulated gallbladder emptying isincomplete during critical illness as assessed by3D ultrasoundMP Plummer1,2*, P Kar1,2, CE Cousins2, MJ Chapman1,2, T Hausken3, KL Jones1, M Horowitz1, AM Deane1,2From ESICM LIVES 2015Berlin, Germany. 3-7 October 2015IntroductionGallbladder dysmotility has been implicated as a puta-tive mechanism underlying acute acalculous cholecystitisand lipid malabsorption in the critically ill, despite nutri-ent-stimulated gallbladder emptying never having beenquantified in this population. In health, endogenouscholecystokinin (CCK) stimulates gallbladder emptying.ObjectivesTo determine fasting and nutrient-stimulated gallbladdervolumes in critically ill patients.MethodsTwenty-four critically ill patients (16M:8F, age 54 ± 16y,BMI 29 ± 6kg/m2, APACHE II 17 ± 5, SOFA score 7.5± 4, day of admission 5 ± 4) with no history of biliarypathology were compared to 12 healthy volunteers(8M:4F, age 55 ± 19, BMI 24 ± 4). All participants werefasted for 8 hours and had a feeding catheter inserted intothe duodenum. At T = -30min 3D images of the gallblad-der were acquired and wall thickness and presence ofsludge recorded. Between T = 0-120min 20% intralipidwas infused into the duodenum at 2kcal/min. Ultrasoundmeasurements of the gallbladder were obtained at 30minintervals until T = 180min. Ejection fraction (%) and thechange in gallbladder volume (mls) were calculated fromT = 0-120min. Blood samples were taken at 30 minuteintervals for the measurement of plasma CCK. Differencesbetween groups were analysed using Student’s t-test orMann-Whitney test as appropriate and data are presentedas mean (SD) or median [IQR]. Unadjusted correlationanalyses were performed for demographic, ultrasound andCCK data.ResultsThe cohorts were well matched for age, but BMI wasgreater (P < 0.01) in the critically ill. In the critically ill,fasting gallbladder volumes were greater (by about threefold) [ICU 60[38-90] vs health 22[15-24]ml; P < 0.001], aswas wall thickness [0.44(0.14) vs 0.26(0.08)mm; P < 0.001].Sludge was evident in the majority (71%) of patients but innone of the healthy participants. The ejection fraction wasless in the critically ill [50[10-82] vs 77[72-82]%; P = 0.01],but there was no difference in the change in gallbladdervolume [22[11-32] vs 16[12-20]ml; P = 0.18]. Gallbladdervolumes post lipid infusion (T = 120min) were muchgreater in the critically ill [22[9-66] vs 4[3-6]ml; P < 0.01].There was no difference in fasting CCK concentration[ICU 5.3(2.5) vs health 4.7(1.2)pmol/L; P = 0.5] or theincremental increase in plasma CCK T0-120 min [5.8(3.8)vs 4.6(3.7)pmol/L; P = 0.37]. There were no associationsbetween fasting CCK concentration and fasting gallbladdervolume, and CCK increment and gallbladder ejectionfraction in the critically ill. There was an associationbetween severity of illness score and gallbladder ejectionfraction [r = -0.5; P < 0.05].ConclusionsWhen fasted, critically ill patients appear to have largerand thicker walled gallbladder than healthy subjects. Inresponse to nutrient stimulation the change in gallblad-der volume is unaffected, but the ejection fraction is lessleading to incomplete emptying.1University of Adelaide, School of Medicine, Adelaide, AustraliaFull list of author information is available at the end of the articlePlummer et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A285http://www.icm-experimental.com/content/3/S1/A285© 2015 Plummer et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided theoriginal work is properly cited.Grant AcknowledgmentStudy supported by a NHMRC Postgraduate Scholarship.Authors’ details1University of Adelaide, School of Medicine, Adelaide, Australia. 2RoyalAdelaide Hospital, Intensive Care Unit, Adelaide, Australia. 3HaukelandUniversity Hospital, Department of Medicine, Bergen, Norway.Published: 1 October 2015doi:10.1186/2197-425X-3-S1-A285Cite this article as: Plummer et al.: Nutrient-stimulated gallbladderemptying is incomplete during critical illness as assessed by 3Dultrasound. Intensive Care Medicine Experimental 2015 3(Suppl 1):A285.Submit your manuscript to a journal and benefi t from:7 Convenient online submission7 Rigorous peer review7 Immediate publication on acceptance7 Open access: articles freely available online7 High visibility within the fi eld7 Retaining the copyright to your article    Submit your next manuscript at 7 springeropen.comPlummer et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A285http://www.icm-experimental.com/content/3/S1/A285Page 2 of 2

Nutrient-stimulated gallbladder emptying is incomplete during critical illness as assessed by 3D ultrasound

Springer - Publisher Connector

NUTRIENT-STIMULATED GALLBLADDER EMPTYING IS INCOMPLETE DURING CRITICAL ILLNESS AS ASSESSED BY 3D ULTRASOUND

POSTER PRESENTATION Open Access
Nutrient-stimulated gallbladder emptying is
incomplete during critical illness as assessed by
3D ultrasound
MP Plummer1,2*, P Kar1,2, CE Cousins2, MJ Chapman1,2, T Hausken3, KL Jones1, M Horowitz1, AM Deane1,2
From ESICM LIVES 2015
Berlin, Germany. 3-7 October 2015
Introduction
Gallbladder dysmotility has been implicated as a puta-
tive mechanism underlying acute acalculous cholecystitis
and lipid malabsorption in the critically ill, despite nutri-
ent-stimulated gallbladder emptying never having been
quantified in this population. In health, endogenous
cholecystokinin (CCK) stimulates gallbladder emptying.
Objectives
To determine fasting and nutrient-stimulated gallbladder
volumes in critically ill patients.
Methods
Twenty-four critically ill patients (16M:8F, age 54 ± 16y,
BMI 29 ± 6kg/m2, APACHE II 17 ± 5, SOFA score 7.5
± 4, day of admission 5 ± 4) with no history of biliary
pathology were compared to 12 healthy volunteers
(8M:4F, age 55 ± 19, BMI 24 ± 4). All participants were
fasted for 8 hours and had a feeding catheter inserted into
the duodenum. At T = -30min 3D images of the gallblad-
der were acquired and wall thickness and presence of
sludge recorded. Between T = 0-120min 20% intralipid
was infused into the duodenum at 2kcal/min. Ultrasound
measurements of the gallbladder were obtained at 30min
intervals until T = 180min. Ejection fraction (%) and the
change in gallbladder volume (mls) were calculated from
T = 0-120min. Blood samples were taken at 30 minute
intervals for the measurement of plasma CCK. Differences
between groups were analysed using Student’s t-test or
Mann-Whitney test as appropriate and data are presented
as mean (SD) or median [IQR]. Unadjusted correlation
analyses were performed for demographic, ultrasound and
CCK data.
Results
The cohorts were well matched for age, but BMI was
greater (P < 0.01) in the critically ill. In the critically ill,
fasting gallbladder volumes were greater (by about three
fold) [ICU 60[38-90] vs health 22[15-24]ml; P < 0.001], as
was wall thickness [0.44(0.14) vs 0.26(0.08)mm; P < 0.001].
Sludge was evident in the majority (71%) of patients but in
none of the healthy participants. The ejection fraction was
less in the critically ill [50[10-82] vs 77[72-82]%; P = 0.01],
but there was no difference in the change in gallbladder
volume [22[11-32] vs 16[12-20]ml; P = 0.18]. Gallbladder
volumes post lipid infusion (T = 120min) were much
greater in the critically ill [22[9-66] vs 4[3-6]ml; P < 0.01].
There was no difference in fasting CCK concentration
[ICU 5.3(2.5) vs health 4.7(1.2)pmol/L; P = 0.5] or the
incremental increase in plasma CCK T0-120 min [5.8(3.8)
vs 4.6(3.7)pmol/L; P = 0.37]. There were no associations
between fasting CCK concentration and fasting gallbladder
volume, and CCK increment and gallbladder ejection
fraction in the critically ill. There was an association
between severity of illness score and gallbladder ejection
fraction [r = -0.5; P < 0.05].
Conclusions
When fasted, critically ill patients appear to have larger
and thicker walled gallbladder than healthy subjects. In
response to nutrient stimulation the change in gallblad-
der volume is unaffected, but the ejection fraction is less
leading to incomplete emptying.
1University of Adelaide, School of Medicine, Adelaide, Australia
Full list of author information is available at the end of the article
Plummer et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A285
http://www.icm-experimental.com/content/3/S1/A285
© 2015 Plummer et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://
creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
Grant Acknowledgment
Study supported by a NHMRC Postgraduate Scholarship.
Authors’ details
1University of Adelaide, School of Medicine, Adelaide, Australia. 2Royal
Adelaide Hospital, Intensive Care Unit, Adelaide, Australia. 3Haukeland
University Hospital, Department of Medicine, Bergen, Norway.
Published: 1 October 2015
doi:10.1186/2197-425X-3-S1-A285
Cite this article as: Plummer et al.: Nutrient-stimulated gallbladder
emptying is incomplete during critical illness as assessed by 3D
ultrasound. Intensive Care Medicine Experimental 2015 3(Suppl 1):A285.
Submit your manuscript to a 
journal and benefi t from:
7 Convenient online submission
7 Rigorous peer review
7 Immediate publication on acceptance
7 Open access: articles freely available online
7 High visibility within the fi eld
7 Retaining the copyright to your article
    Submit your next manuscript at 7 springeropen.com
Plummer et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A285
http://www.icm-experimental.com/content/3/S1/A285
Page 2 of 2


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Nutrient-stimulated gallbladder emptying is incomplete during critical illness as assessed by 3D ultrasound

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