Gastrointestinal motility and gastric tube feeding in mechanically ventilated patients

Abstract

These data suggest that morphine administration affects antroduodenal motility in mechanically ventilated patients. The gastrointestinal motor pattern involved in impaired gastric emptying in morphine-treated patients is characterized by antral hypomotility and persisting duodenal activity fronts during continuous intragastric feeding. The observed motility patterns suggest that early administration of enteral feeding might be more effective into the duodenum or jejunum than into the stomach of mechanically ventilated patients.

Effect of dopamine on gastrointestinal motility during critical illness

“…In fasting patients under deep sedation and mechanical ventilation we found an absence of MMCs in the stomach with antral hypomotility, while in contrast MMCs occur most frequently in the duodenum with a decrease in the relative duration of irregular (phase II) mechanical activity [2]. When fed intragastrically with a standard polymeric diet, most patients demonstrated a failure to convert their fasting motility pattern to the fed pattern [3,12]. Opiates are suspected of being responsible for some abnormalities, since gastrointestinal motility disturbances disappear after weaning from mechanical ventilation and opiates interruption [12].…”

“…These precede the quiescence period (phase I) of the next migrating motor complex, since these complexes succeed one another without interruption as long as the subject is fasting. During feeding this fasting motility pattern is normally disrupted and replaced by a pattern of continuous irregular motor activity (ªfed patternº) [11], although previous studies [3,12] suggest that the fed pattern may be absent in some enterally fed critically ill patients.…”

Prevention of Infectious Complications in Surgical Patients: Potential Role of Probiotics

“…The proximal small bowel bacterial overgrowth was correlated to bacterial translocation to extraintestinal sites such as the mesenteric lymph nodes, liver and spleen [31]. Likewise, administration of morphine in intensive care patients reduced anteroduodenal motility [27]. …”

“…In Utrecht, several experimental and clinical studies concerning acute pancreatitis, bile duct obstruction and the critically ill have provided insight into the interactions between gastrointestinal motility, bacterial overgrowth, bacterial translocation and infectious complications [21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40]. Being aware of the continuing controversy and the risks of prophylactic use of antibiotics, research is currently focused on probiotics.…”

Effect of Prolonged Hyperdynamic Endotoxemia on Jejunal Motility in Fasted and Enterally Fed Pigs

“…However, this experimental model of endotoxemia induced by continuous endotoxin infusion may not necessarily reproduce the pathophysiologic conditions and the compromised immune status of many of the patients admitted to the ICU, since these patients often receive mechanical ventilation and additional therapy such as antibiotics or opiates that may severely disturb the motility pattern. 27 This hyperdynamic endotoxemia model reveals that the jejunal motility disorders in the response to endotoxin infusion include increased MMC migration velocity and increased MMC cycling frequency, with absence or shortened phase 2. These changes were still manifest 1 day after endotoxin administration during feeding, indicating a protracted effect of endotoxin challenge, whereas the MMC pattern was restored 4 days after endotoxin administration.…”