The efficacy and safety of prokinetic agents in critically ill patients receiving enteral nutrition: a systematic review and meta-analysis of randomized trials

Lewis, Kim; Alqahtani, Zuhoor; McIntyre, Lauralyn; Almenawer, Saleh A.; Alshamsi, Fayez; Rhodes, Andrew; Evans, Laura; Angus, Derek C.; Alhazzani, Waleed

doi:10.1186/s13054-016-1441-z

Cited by 120 publications

(111 citation statements)

References 59 publications

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“…There was no significant effect on the risk of pneumonia or vomiting. The majority of trials examined the effect of metoclopramide or erythromycin; subgroup analysis by drug class was underpowered to detect important subgroup differences [606]. We considered the desirable consequences (lower risk of feeding intolerance) and the low quality of evidence showing no difference in mortality or pneumonia, and issued a weak recommendation for using prokinetic agents (metoclopramide or erythromycin) to treat feeding intolerance in patients with sepsis.…”

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confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods:The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

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confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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“…Intestinal dysfunction can be suspected in cases of diarrhea, vomiting, bloating, abdominal pain, and/or digestive bleeding . Prokinetic drugs may improve gastroparesis and enable early nutrition . Diarrhea should be promptly investigated and managed.…”

Section: Discussionmentioning

confidence: 99%

Seven Deadly Sins of Nutrition Therapy in Critically Ill Patients

et al. 2019

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This article presents 7 nutrition steps that, if not followed by the clinical staff, may be metaphorically considered as “7 deadly sins” of nutrition therapy. In this review, we suggest approaches that must be avoided or accomplished to increase compliance with the “Ten Commandments” of good nutrition practice in the intensive care setting. Multiple aggressive and simultaneous sets of therapies are implemented in the intensive care setting, which include nutrition and metabolic support as important components in these therapies. “Sins” should be remembered as a mnemonic device for nutrition standard care in the intensive care unit; this incorporates nutrition adequacy and protocol adherence.

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“…Previous studies indicated that MMCs presented a dose-dependent response to erythromycin in humans [12, 25], and the dose of erythromycin varied greatly in different post-pyloric placement trials [26, 27]. Thus, 2 g of erythromycin was ultimately chosen on the basis of the dose-dependent property and reference to the drug instruction, although higher doses are available and usually adopted to control Legionella infection.…”

Section: Discussionmentioning

confidence: 99%

Erythromycin versus metoclopramide for post-pyloric spiral nasoenteric tube placement: a randomized non-inferiority trial

Ouyang

Lei

et al. 2018

Intensive Care Med

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PurposeTo determine whether erythromycin is non-inferior to metoclopramide in facilitating post-pyloric placement of self-propelled spiral nasoenteric tubes (NETs) in critically ill patients.MethodsA prospective, multicenter, open-label, parallel, and non-inferiority randomized controlled trial was conducted comparing erythromycin with metoclopramide in facilitating post-pyloric placement of spiral NETs in critically ill patients admitted to intensive care units (ICUs) of eight tertiary hospitals in China. The primary outcome was procedure success defined as post-pyloric placement (spiral NETs reached the first portion of the duodenum or beyond confirmed by abdominal radiography 24 h after tube insertion).ResultsA total of 5688 patients were admitted to the ICUs. Of these, in 355 patients there was a plan to insert a nasoenteric feeding tube, of whom 332 were randomized, with 167 patients assigned to the erythromycin group and 165 patients assigned to the metoclopramide group. The success rate of post-pyloric placement was 57.5% (96/167) in the erythromycin group, as compared with 50.3% (83/165) in the metoclopramide group (a difference of 7.2%, 95% CI − 3.5% to 17.9%), in the intention-to-treat analysis, not including the prespecified margin of − 10% for non-inferiority. The success rates of post-D1 (reaching the second portion of the duodenum or beyond), post-D2 (reaching the third portion of the duodenum or beyond), post-D3 (reaching the fourth portion of the duodenum or beyond), and proximal jejunum placement and the incidence of any adverse events were not significantly different between the groups.ConclusionsErythromycin is non-inferior to metoclopramide in facilitating post-pyloric placement of spiral NETs in critically ill patients. The success rates of post-D1, post-D2, post-D3, and proximal jejunum placement were not significantly different.

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The efficacy and safety of prokinetic agents in critically ill patients receiving enteral nutrition: a systematic review and meta-analysis of randomized trials

Cited by 120 publications

References 59 publications

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Seven Deadly Sins of Nutrition Therapy in Critically Ill Patients

Erythromycin versus metoclopramide for post-pyloric spiral nasoenteric tube placement: a randomized non-inferiority trial

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