Gastric emptying in mechanically ventilated critically ill patients: effect of neuromuscular blocking agent.
OBJECTIVE
To assess gastrointestinal function in critically ill patients receiving muscle relaxant and to test clinical tolerance to enteral nutrition.


METHODS
Prospective study in an intensive care unit.


METHODS
20 critically ill patients requiring sedation with muscle relaxant to obtain adequate mechanical ventilation.


RESULTS
Patients were randomly selected to receive infusions of opioid sedation during the first session (session 1) and the same sedation with muscle relaxation (cisatracurium) during the second session (session 2). Gastric emptying was assessed by the paracetamol absorption technique. Following the paracetamol absorption 200 ml enteral feed was given, and the residual gastric volume was measured 1 and 2 h after feeding. The maximum plasma concentration (Cmax) was 14 mg/l (range 5-26) when patients received sedation, and 12 mg/l (range 5-30) when they received muscle relaxant. The target time for reaching the maximum plasma concentration (Tmax) was 30 min (range 20-60) and 35 min (range 20-60), respectively, in sessions 1 and 2. There was no significant difference between the two session as regards Tmax, Cmax, or AUC(0-120). The residual volumes were 110+/-65 ml (H1) and 95+/-76 ml (H2) during session 1 and 125+/-85 ml (H1) and 105+/-90 ml (H2) during session 2.


CONCLUSIONS
Enteral feeding is one of the most effective methods of supporting nutritional needs in the critically ill patient. We conclude that in critically ill patients requiring sedation gastric emptying is not improved by neuromuscular blocking agent.
Tamion
Fabienne
F
Medical Intensive Care Unit, Hospital Charles Nicolle, Rouen University, 1 rue de Germont, 76031 Rouen, France. fabienne.tamion@chu-rouen.fr
Hamelin
Karine
K
Duflo
Annie
A
Girault
Christophe
C
Richard
Jean-Christophe
JC
Bonmarchand
Guy
G
D000082:Acetaminophen / Q000493:pharmacokinetics; D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000493:pharmacokinetics; D001279:Atracurium / Q000031:analogs & derivatives* / Q000494:pharmacology*; D016292:Procedural Sedation; D016638:Critical Illness; D005260:Female; D005746:Gastric Emptying / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000494:pharmacology*; D011446:Prospective Studies; D012121:Respiration, Artificial; D013997:Time Factors
D018712:Analgesics, Non-Narcotic; D009466:Neuromuscular Blocking Agents; D001279:Atracurium; D000082:Acetaminophen; C101584:cisatracurium