title: Gastric emptying in critically ill patients is accelerated by adding cisapride to a standard enteral feeding protocol: results of a prospective, randomized, controlled trial.
abstract: OBJECTIVE
  To investigate the effect of cisapride, a relatively new prokinetic agent, on gastric emptying in critically ill patients.
  
  
  METHODS
  Prospective, randomized, controlled study.
  
  
  METHODS
  Adult medical/surgical intensive care unit in a university hospital.
  
  
  METHODS
  Twenty-one consecutively enrolled patients, requiring prolonged mechanical ventilation and enteral feeding.
  
  
  METHODS
  Patients were randomized to receive either no cisapride or 10 mg of cisapride four times daily, which was added to a standard enteral nutrition feeding protocol.
  
  
  RESULTS
  Gastric emptying was evaluated by daily measurements of gastric residue and on days 5 through 7 by bedside scintigraphy. Normal values for gastric clearance of a tracer-labeled test meal and for measurements obtained in the supine position were determined in ten healthy volunteers. The mean time at which 50% of the technetium 99m-labeled test meal was eliminated from the stomach (T 1/2) in this control group was 31 +/- 15 mins. In ten critically ill patients (enteral nutrition group), gastric emptying was markedly delayed after 5 to 7 days of enteral feeding (mean T 1/2 = 78 +/- 40 mins; p < .002 as compared with the control group). In contrast, patients treated with cisapride (cisapride group) showed an accelerated gastric emptying (mean T 1/2 = 18 +/- 7 mins; p > .05 as compared with controls; p < .005 as compared with enteral nutrition group). The mean gastric residue over a 1-wk period was also significantly lower in the cisapride group than in the enteral nutrition group (17.7 +/- 8.9 vs. 94.5 +/- 33.4 mL; p < .001).
  
  
  CONCLUSIONS
  The data indicate that gastric emptying in critically ill, sedated, and mechanically ventilated patients can be significantly improved by adding cisapride to a routine enteral feeding protocol.
authors.affiliation: Department of Intensive Care Medicine, University Hospital, Vrije Universiteit Brussel, Belgium.
authors.forename: H D
authors.initials: HD
authors.lastname: Spapen
authors.forename: L
authors.initials: L
authors.lastname: Duinslaeger
authors.forename: M
authors.initials: M
authors.lastname: Diltoer
authors.forename: R
authors.initials: R
authors.lastname: Gillet
authors.forename: A
authors.initials: A
authors.lastname: Bossuyt
authors.forename: L P
authors.initials: LP
authors.lastname: Huyghens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000494:pharmacology*; D020117:Cisapride; D016638:Critical Illness; D004750:Enteral Nutrition; D005260:Female; D005746:Gastric Emptying / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000494:pharmacology*; D011446:Prospective Studies; D011877:Radionuclide Imaging; D013270:Stomach / Q000000981:diagnostic imaging
chemical_list: D000897:Anti-Ulcer Agents; D010880:Piperidines; D020117:Cisapride