Impaired gastric emptying in mechanically ventilated, critically ill patients

Abstract

Gastric emptying is delayed in critically ill patients. The important consequences of this phenomenon include intolerance to enteral nutrition and gastric colonization. Strategies to minimize the use of narcotics may improve gastric emptying. Studies to examine the effect of gastrointestinal prokinetic agents on gastric emptying are needed.

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

“…As pyloric dysfunction is frequent in critically ill patients, resulting in delayed absorption and high volumes of gastric residues [2], low-dose erythromycin was used on a systematic basis in the present study, since it has been shown to increase motility in unselected ICU patients [4,15]. In ICU settings, metoclopramide, cisapride, and erythromycin have been used to facilitate tube progression beyond the pylorus, although with variable success.…”

“…Feeding via the enteral route is considered to be the better feeding procedure, but gastric feeding may be difficult in ventilated and sedated intensive care unit (ICU) patients. It may result in the delivery of insufficient amounts of energy [1,2]. Critically ill patients exhibit various types of gastrointestinal motility disorders, mainly pyloric dysfunction, retrograde oesophageal motility, and general reduction of migration complexes [3].…”

Endotoxin inhibits gastric emptying in rats via a capsaicin-sensitive afferent pathway

“…A delayed gastric emptying is commonly observed in many pathological circumstances associated with endotoxemia such as cirrhosis (Acalovschi et al 1997;Isobe et al 1994), diabetes, chronic renal failure (Kao et al 1996), head injury (Kao et al 1998), critical illness (Heyland et al 1996) or the post-operative period (Ratych et al 1991;Resnick et al 1997;van Berge Henegouwen et al 1997). In these conditions, a delay in the emptying of nutrients from the stomach is the principal cause of dyspepsia, a significant observation considering the lack of prior evidence about the gastric emptying of nutrient solid meals in endotoxemia.…”

How to optimise antimicrobial prescriptions in the Intensive Care Unit: principles of individualised dosing using pharmacokinetics and pharmacodynamics

“…GI hypoperfusion commonly occurs with haemodynamic instability [18]. The consequences of this are decreased absorption of enterally administered drugs, in which case intravenous administration should be preferred.…”