Gastrointestinal promotility drugs in the critical care setting: A systematic review of the evidence*

Booth, Christopher M.; Heyland, Daren K.; Paterson, William G.

doi:10.1097/00003246-200207000-00005

Cited by 151 publications

(69 citation statements)

References 55 publications

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“…Use of promotility agents (eg, erythromycin or metoclopramide) improves tolerance of intragastric feedings and reduces the likelihood of gastroesophageal reflux and pulmonary aspiration. 11,64,[94][95][96][97][98] For example, over a period of 5 days, Reignier et al 99 studied GRVs in 20 critically ill, tube-fed patients who received intravenous erythromycin compared with those of 20 similar patients who received only a placebo. On the first day, GRV was smaller in the erythromycin group than in the placebo group (3 PM, 15 Ϯ 7 mL vs 52 Ϯ 14 mL, P Ͻ .05; 9 PM, 29 Ϯ 15 mL vs 100 Ϯ 20 mL, P Ͻ .001).…”

Section: Interventions To Prevent Aspirationmentioning

confidence: 99%

Effect of gastrointestinal motility and feeding tube site on aspiration risk in critically ill patients: a review

2004

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Section: Interventions To Prevent Aspirationmentioning

confidence: 99%

Effect of gastrointestinal motility and feeding tube site on aspiration risk in critically ill patients: a review

2004

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“…1) Metoclopramide is a dopamine D2 receptor antagonist with central and peripheral effects, as well as a 5-HT3 receptor antagonist and a 5-HT4 receptor agonist. Metoclopramide increases gastric motility and has a moderate stimulant effect on the small bowel, but its prokinetic activity is in general limited to the proximal gut [78]. The substance might be useful in critically ill patients but seems to be ineffective in patients with postoperative ileus [79].…”

Section: Specific Therapeutic Measuresmentioning

confidence: 99%

“…Erythromycin is most effective when used intravenously; there is some evidence of efficacy of the oral preparation in long-term use, for instance, in a 4-week trial of patients with scleroderma. In critically ill patients, erythromycin effectively improves gastric emptying, and there is a trend towards shorter times necessary for tube placement [78]. The recommended dose is 250 mg orally b.i.d.…”

Section: Specific Therapeutic Measuresmentioning

confidence: 99%

Gastrointestinal motility in acute illness

Fruhwald

Holzer

Metzler

2008

Wien Klin Wochenschr

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Critical illness affects gastrointestinal motility - not only as a primary problem, which brings the patient to the intensive care unit (ICU), but also as a complication consecutive to the ICU stay. Motility disturbances may result from impaired function of gastrointestinal muscle, pacemaker cell function and nerve activity. The most important neural control system is the enteric nervous system that contains the largest collection of neurons (10(8) cells) outside the central nervous system. Through its organization it can operate independently of the brain and generate motility patterns according to need: a postprandial motility pattern starting after food intake, and an interdigestive motility pattern starting several hours after a meal. Undisturbed intestinal motility depends critically on a balanced interaction between inhibition and excitation, and a disturbance in this balance leads to severe derangements of intestinal motility. These motility disturbances differ in clinical appearance and location but can affect all parts of the gastrointestinal tract. This review focuses on select motility disturbances such as gastroparesis, postoperative ileus, and Ogilvie's syndrome. Generally effective methods to treat these conditions are given. Finally, we focus on special management options to prevent such motility disturbances or to reduce their severity.

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“…Prokinetic agents may be useful in patients with gastroparesis [34]. However, cisapride was withdrawn from the market because of its association with potentially lethal arrhythmias.…”

Section: Strategies For Risk Reductionmentioning

confidence: 99%

Risk of aspiration in patients on enteral nutrition: Frequency, relevance, relation to pneumonia, risk factors, and strategies for risk reduction

Mizock

2007

Curr Gastroenterol Rep

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Upper digestive feeding intolerance, as evidenced by high gastric residual volume and vomiting, is the most common complication among hospitalized patients receiving enteral nutrition. These patients are at high risk of developing aspiration pneumonia, which in turn is associated with prolonged hospital stay and increased mortality. Most episodes of aspiration are small in volume and do not lead to pneumonia. The likelihood of pneumonia increases with multiple aspirations. Pneumonia is also more common in critically ill patients who have bacterial colonization of the oropharynx. Gastric residual volume is commonly used as a means to assess aspiration risk during tube feeding. However, recent studies have demonstrated that this measurement has limited sensitivity. The approach to minimizing the frequency of aspiration during tube feeding involves assessment of the patient's degree of risk and initiation of appropriate measures directed at risk reduction.

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Gastrointestinal promotility drugs in the critical care setting: A systematic review of the evidence*

Cited by 151 publications

References 55 publications

Effect of gastrointestinal motility and feeding tube site on aspiration risk in critically ill patients: a review

Effect of gastrointestinal motility and feeding tube site on aspiration risk in critically ill patients: a review

Gastrointestinal motility in acute illness

Risk of aspiration in patients on enteral nutrition: Frequency, relevance, relation to pneumonia, risk factors, and strategies for risk reduction

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