Erythromycin Facilitates Postpyloric Placement of Nasoduodenal Feeding Tubes in Intensive Care Unit Patients: Randomized, Double‐Blinded, Placebo‐Controlled Trial

Abstract

These data suggest that, overall, E is effective in facilitating placement of a nasoenteric feeding tube into the duodenum in ICU patients. It is clearly beneficial in those patients with normal mental status and may be useful in patients with diabetes mellitus.

Erythromycin and Position Facilitated Placement of Postpyloric Feeding Tubes in Burned Patients

“…The first is the use of a prokinetic agent; we confirmed the previously reported value of erythromycin in facilitating the postpyloric placement of feeding tubes [9, 10, 11]. The second is the use of patient positioning to allow gravity in assisting in the migration and movement of the feeding tube.…”

“…Di Lorenzo et al [9]who used erythromycin to facilitate the transpyloric migration of feeding tube in children documented this in 1990. That erythromycin accelerates the transpyloric migration of feeding tubes has been further confirmed in prospective randomized trials in healthy volunteers [10]and a nonselected group of critically ill patients [11]. …”

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

“…The success rate was 58%, when considering the tubes that reached the stomach and were not pulled out during the first hours (63/108): this is a success rate similar to that of weighted feeding-tubes progression using erythromycin as prokinetic [9], showing that the Bengmark tubes can be used in ICU patients.…”

“…Placing the patient in the right lateral position, and tracking a weighted tube into proper small bowel position by auscultation resulted in 83% successful placement. In another centre, the migration of weighted feeding tubes has been increased from 35% to 61% with the help of erythromycin [9], while others have observed a higher migration rate with unweighted tubes compared with weighted (92% vs 56%) [13]. Using magnetic guidance has also been advocated [14].…”

“…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]. In the critically ill, erythromycin has been shown to improve gastric emptying [4,20], and to increase migration of nasoenteric feeding tubes from 35% to 61% in placebocontrolled settings [9]. The patients enrolled in the present study were severely ill as shown by the elevated SAPS II and the SOFA scores.…”