Prokinetic drugs for gastric emptying in critically ill ventilated patients: Analysis through breath testing

Pathophysiology and Treatment of Gastrointestinal Motility Disorders in the Acutely Ill

“…In trials of critically ill patients, albeit small in number, erythromycin appears to be a more potent promotility drug than metoclopramide and leads to more frequent resolution of enteral feed intolerance . However, erythromycin use is associated with rapid tolerance to its effect, which may explain why administration of both drugs (erythromycin and metoclopramide) appears to be more effective than erythromycin alone …”

“…82,83 However, erythromycin use is associated with rapid tolerance to its effect, which may explain why administration of both drugs (erythromycin and metoclopramide) appears to be more effective than erythromycin alone. 99,118,119 There is considerable variation between individuals as to what GRV defines gastric dysmotility that warrants administration of a promotility drug. Even among experts, there is considerable variation with the threshold value that represents large GRVs, ranging from 200-500 mL.…”

Gastrointestinal dysmotility in critically ill patients

“…Combination therapy was also associated with a lesser degree of drug tachyphylaxis and up to 60% of patients remained responsive at day 7 of treatment [ 95 ]. A more recent study demonstrated that combined treatment with metoclopramide 10 mg/6 h and a single low-dose IV erythromycin (10 mg/h) best facilitates gastric emptying in critically ill, mechanically ventilated patients [ 96 ]. Other novel gastrokinetic drugs, such as non-antibiotic motilin agonists, ghrelin agonists, or cholecystokinin antagonists (e.g., dexloxiglumide), could be of interest but have yet to be investigated.…”

Comparing the Effects of Acupuncture and Pharmacologic Therapies on Delayed Gastric Emptying: A Prospective, Block-Randomized, Single-Blinded, Parallel Clinical Trial

“…Compared with PN, EN appears more physiological and varied clinical benefits (2,(4)(5)(6)(7)(8)(9). Both European and American nutrition societies recommend using EN as first-line support in early feeds in patients with a functional gut (10)(11)(12).…”

“…In order to reduce the incidence of DGE, different methods, such as surgical techniques (16,21), pharmacological therapies (7,22), and alternative and complementary medicine (23), have been used. However, to the best of the researchers' knowledge, the best methods or combination regimens have not yet been found.…”