title: Erythromycin and early enteral nutrition in mechanically ventilated patients.
abstract: OBJECTIVE
  To determine whether erythromycin facilitates early enteral nutrition in mechanically ventilated, critically ill patients.
  
  
  METHODS
  Prospective, randomized, placebo-controlled, single-blind trial.
  
  
  METHODS
  General intensive care unit in a university-affiliated general hospital.
  
  
  METHODS
  Forty consecutive critically ill patients receiving invasive mechanical ventilation and early nasogastric feeding.
  
  
  METHODS
  Patients were assigned randomly to intravenous erythromycin (250 mg/6 hrs; n = 20) or a placebo (intravenous 5% dextrose, 50 mL/6 hrs; n = 20) for 5 days. The first erythromycin or 5% dextrose injection was given at 8 am on the day after intubation. One hour later, a daily 18-hr enteral nutrition regimen via a 14-Fr gastric tube was started. Residual gastric volume was aspirated and measured every day at 9 am, 3 pm, 9 pm, and 3 am. Enteral nutrition was discontinued if residual gastric volume exceeded 250 mL or the patient vomited.
  
  
  RESULTS
  On the first day, residual gastric volume was smaller in the erythromycin than in the placebo group (3 pm, 15 +/- 7 mL vs. 52 +/- 14 mL, p <.05; 9 pm, 29 +/- 15 mL vs. 100 +/- 20 mL, p <.001; 3 am, 11 +/- 4 mL vs. 54 +/- 13 mL, p <.05). With erythromycin, residual gastric volume at 9 pm was smaller on the second day (33 +/- 11 mL vs. 83 +/- 19 mL, p <.01) and residual gastric volume at 3 pm was smaller on the third day (39 +/- 15 mL vs. 88 +/- 19 mL, p <.05) than with placebo. On the fourth and fifth days, the differences in residual gastric volume were not significant. Enteral nutrition was discontinued before the end of the 5-day period in seven of the 20 erythromycin patients and 14 of the 20 placebo patients (p <.001).
  
  
  CONCLUSIONS
  In critically ill patients receiving invasive mechanical ventilation, erythromycin promotes gastric emptying and improves the chances of successful early enteral nutrition.
authors.affiliation: Service de Réanimation Polyvalente, Centre Hospitalier Departemental, La Roche-sur-Yon, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Reignier
authors.forename: Said
authors.initials: S
authors.lastname: Bensaid
authors.forename: Dominique
authors.initials: D
authors.lastname: Perrin-Gachadoat
authors.forename: Michelle
authors.initials: M
authors.lastname: Burdin
authors.forename: Richard
authors.initials: R
authors.lastname: Boiteau
authors.forename: Alain
authors.initials: A
authors.lastname: Tenaillon
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003422:Critical Care; D004750:Enteral Nutrition; D004917:Erythromycin / Q000627:therapeutic use*; D005260:Female; D005746:Gastric Emptying / Q000187:drug effects; D006801:Humans; D008297:Male; D012121:Respiration, Artificial; D016037:Single-Blind Method
chemical_list: D000900:Anti-Bacterial Agents; D004917:Erythromycin