Document Detail

Prokinetic therapy for feed intolerance in critical illness: one drug or two?
MedLine Citation:
PMID:  17828038     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To compare the efficacy of combination therapy, with erythromycin and metoclopramide, to erythromycin alone in the treatment of feed intolerance in critically ill patients. DESIGN: Randomized, controlled, double-blind trial. SETTING: Mixed medical and surgical intensive care unit. PATIENTS: Seventy-five mechanically ventilated, medical patients with feed intolerance (gastric residual volume > or =250 mL). INTERVENTIONS: Patients received either combination therapy (n = 37; 200 mg of intravenous erythromycin twice daily + 10 mg of intravenous metoclopramide four times daily) or erythromycin alone (n = 38; 200 mg of intravenous erythromycin twice daily) in a prospective, randomized fashion. Gastric feeding was re-commenced and 6-hourly gastric aspirates performed. Patients were studied for 7 days. Successful feeding was defined as a gastric residual volume <250 mL with the feeding rate > or =40 mL/hr, over 7 days. Secondary outcomes included daily caloric intake, vomiting, postpyloric feeding, length of stay, and mortality. MEASUREMENTS AND MAIN RESULTS: Demographic data; use of inotropes, opioids, or benzodiazepines; and pretreatment gastric residual volume were similar between the two groups. The gastric residual volume was significantly lower after 24 hrs of treatment with combination therapy, compared with erythromycin alone (136 +/- 23 mL vs. 293 +/- 45 mL, p = .04). Over the 7 days, patients treated with combination therapy had greater feeding success, received more daily calories, and had a lower requirement for postpyloric feeding, compared with erythromycin alone. Tachyphylaxis occurred in both groups but was less with combination therapy. Sedation, higher pretreatment gastric residual volume, and hypoalbuminemia were significantly associated with a poor response. There was no difference in the length of hospital stay or mortality rate between the groups. Watery diarrhea was more common with combination therapy (20 of 37 vs. 10 of 38, p = .01) but was not associated with enteric infections, including Clostridium difficile. CONCLUSIONS: In critically ill patients with feed intolerance, combination therapy with erythromycin and metoclopramide is more effective than erythromycin alone in improving the delivery of nasogastric nutrition and should be considered as the first-line treatment.
Nam Q Nguyen; Marianne Chapman; Robert J Fraser; Laura K Bryant; Carly Burgstad; Richard H Holloway
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  35     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-12-17     Completed Date:  2008-02-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2561-7     Citation Subset:  AIM; IM    
Department of Gastroenterology and Hepatology, University of Adelaide, Royal Adelaide Hospital, South Australia.
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MeSH Terms
Antiemetics / therapeutic use*
Critical Illness
Double-Blind Method
Drug Therapy, Combination
Enteral Nutrition / adverse effects*
Erythromycin / therapeutic use*
Gastrointestinal Agents / therapeutic use*
Metoclopramide / therapeutic use*
Middle Aged
Prospective Studies
Reg. No./Substance:
0/Antiemetics; 0/Gastrointestinal Agents; 114-07-8/Erythromycin; 364-62-5/Metoclopramide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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