Posters

Sequential single doses of cisapride, erythromycin, and metoclopramide in critically ill patients intolerant to enteral nutrition: A randomized, placebo-controlled, crossover study

“…9 Unfortunately, gastrointestinal motility is frequently impaired in critically ill patients. 10 This may result in intolerance to EN, [11][12][13][14] delayed absorption of enterally administered medications, gastric colonization with Gram-negative bacteria, 15,16 and an increased risk of nosocomial pneumonia. [17][18][19][20] Gastrointestinal motility dysfunction most commonly manifests as large volumes of aspirated gastric residuals or vomiting.…”

“…[17][18][19][20] Gastrointestinal motility dysfunction most commonly manifests as large volumes of aspirated gastric residuals or vomiting. [11][12][13][14] Prokinetic agents such as cisapride, erythromycin, and metoclopramide are often utilized to promote gastric emptying in critically ill patients who are intolerant to gastric EN. 21 The results of studies comparing individual agents with placebo have demonstrated these agents to be effective in increasing gastric emptying, with minimal adverse effects.…”

“…11 This is of concern because the reported frequency rate of intolerance is 48%-52% with the development of elevated volumes of aspirated gastric residuals representing the primary reason for discontinuing EN. [11][12][13][14] Gastroduodenal reflux in critically ill patients is likely the result of deficiencies of phase 3 contractions in the gastric antrum to produce dyskinetic propagation of hypokinetic contractions. 10 These irregularities may be related to dysfunction of the interstitial cells of Cajal that are concentrated in the gastric antrum and act as the "pacemaker" of gastrointestinal motility.…”