Erythromycin and early enteral nutrition in mechanically ventilated patients.
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.
Reignier
Jean
J
Service de Réanimation Polyvalente, Centre Hospitalier Departemental, La Roche-sur-Yon, France.
Bensaid
Said
S
Perrin-Gachadoat
Dominique
D
Burdin
Michelle
M
Boiteau
Richard
R
Tenaillon
Alain
A
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
D000900:Anti-Bacterial Agents; D004917:Erythromycin