title: Intravenous erythromycin facilitates bedside placement of postpyloric feeding tubes in critically ill adults: a double-blind, randomized, placebo-controlled study.
abstract: OBJECTIVE To evaluate the efficacy of intravenous erythromycin as a method to facilitate feeding tube placement into the small intestine in critically ill patients. DESIGN Double blind, randomized, controlled trial. SETTING Medical and surgical intensive care units in an academic medical center. PATIENTS Prospective cohort of 36 consecutive adults requiring intensive care unit care and enteral tube feeding for nutritional support. INTERVENTION Infusion of a single dose of intravenous erythromycin (500 mg) or saline before placement of 10-Fr feeding tubes using a standardized active bedside protocol. MEASUREMENTS AND MAIN RESULTS We determined the success rate of feeding tube placement into or beyond the second portion of the duodenum and the time required for this procedure by experienced nurses. The feeding tube was considered to be postpyloric when the tip was in the second portion of the duodenum or beyond. The predictive value of a serial step-up in gastrointestinal aspirate pH from < or = 5.0 to > or = 6.0 was also determined. Use of intravenous erythromycin significantly improved the rate of feeding tube placement into the duodenum or jejunum (erythromycin group, 13 of 14 patients or 93% vs. the control group, 12 of 22 patients or 55%; p < .03). Erythromycin administration also significantly decreased the procedure time from 25 +/- 3 to 15 +/- 2 mins (p < .04). Feeding tube placement into either duodenum or jejunum was confirmed in all 18 patients with a pH step-up from < or = 5.0 to > or = 6.0.
  
  
  CONCLUSIONS
  A single bolus dose of intravenous erythromycin facilitates active bedside placement of postpyloric feeding tubes in critically ill adult patients.
authors.affiliation: Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, GA 30322, USA.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Griffith
authors.forename: A Therese
authors.initials: AT
authors.lastname: McNally
authors.forename: Cindy H
authors.initials: CH
authors.lastname: Battey
authors.forename: Susan S
authors.initials: SS
authors.lastname: Forte
authors.forename: Angela M
authors.initials: AM
authors.lastname: Cacciatore
authors.forename: Elaina E
authors.initials: EE
authors.lastname: Szeszycki
authors.forename: Glen F
authors.initials: GF
authors.lastname: Bergman
authors.forename: Celeste E
authors.initials: CE
authors.lastname: Furr
authors.forename: Fredrick B
authors.initials: FB
authors.lastname: Murphy
authors.forename: John R
authors.initials: JR
authors.lastname: Galloway
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Ziegler
mesh_terms: D016638:Critical Illness; D004311:Double-Blind Method; D004750:Enteral Nutrition; D004917:Erythromycin / Q000627:therapeutic use*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008297:Male; D008875:Middle Aged
chemical_list: D005765:Gastrointestinal Agents; D004917:Erythromycin