Gastric emptying in critically ill patients is accelerated by adding cisapride to a standard enteral feeding protocol

Abstract

The data indicate that gastric emptying in critically ill, sedated, and mechanically ventilated patients can be significantly improved by adding cisapride to a routine enteral feeding protocol.

Progression rate of self-propelled feeding tubes in critically ill patients

“…In ICU settings, metoclopramide, cisapride, and erythromycin have been used to facilitate tube progression beyond the pylorus, although with variable success. Metoclopramide has unpredictable effects while cisapride, an excellent prokinetic agent [16,17], has un- wanted deleterious cardiac side effects in critically ill related to its ability to increase the QT interval on ECG [18]. It has been shown in healthy volunteers that 40 mg of erythromycin induces premature antral activity, which migrates through the small intestine, while 200 mg causes a prolonged period of enhanced antral activity due to direct muscular receptor activation [19].…”

Parenteral with enteral nutrition in the critically ill

“…The rate of administration was 100±150 ml/h, with a standard rinse of 50 ml (25±100 ml) water adjusted to the daily requirement assessed by daily intake and output. Residual volume was measured before each feeding; feeding was delayed by 4 h if this was more than 300 ml, and cisapride (10 mg every 6 h Propulsid, Janssen-Cilag, Issy Les Moulineaux, France) was added [15].…”

Sequential single doses of cisapride, erythromycin, and metoclopramide in critically ill patients intolerant to enteral nutrition: A randomized, placebo-controlled, crossover study

“…53,54 Studies comparing individual agents with placebo have demonstrated prokinetic agents to be effective for promoting gastric emptying in critically ill patients. [22][23][24][25] In a randomized, controlled study of 21 critically ill patients, Spapen et al 22 showed that cisapride promotes gastric emptying as assessed by the volume of gastric residuals and bedside scintigraphy compared with placebo. During the 7-day study period, the mean gastric residual volume was significantly higher and gastric emptying significantly slower in the placebo group than in the cisapride group (p < .005).…”

“…21 The results of studies comparing individual agents with placebo have demonstrated these agents to be effective in increasing gastric emptying, with minimal adverse effects. [22][23][24][25] Unfortunately, these studies were not selective for patients with proven intolerance to EN.…”