Use of novel prokinetic agents to facilitate return of gastrointestinal motility in adult critically ill patients.
OBJECTIVE
Intolerance of enteral feeding due to impaired gastrointestinal motility is common in critically ill patients. Strategies to prevent or treat gastrointestinal hypomotility include the use of prokinetic agents. Many currently employed prokinetic agents are associated with serious adverse drug reactions. The novel prokinetic agents - alvimopan, tegaserod, and dexloxiglumide - are reviewed.


RESULTS
Alvimopan exerts mixed, but generally favorable, effects on restoration of gastrointestinal motility in patients with postoperative ileus. The observation of increased opioid requirements (without increased pain scores) and associated clinical ramifications requires further study. Tegaserod stimulates the peristaltic reflex and improves motility in multiple sites along the gastrointestinal tract. Its efficacy in improving gastrointestinal hypomotility in the critically ill population has not yet been determined. Furthermore, its use has been associated with the development of ischemic colitis and increased requirement for abdominal/pelvic surgery. Dexloxiglumide may be beneficial for improving gastric emptying in critically ill patients, especially those receiving lipid-enriched enteral feeds.


CONCLUSIONS
Novel prokinetic agents show promise for management of gastrointestinal hypomotility in the critically ill population. However, further study is required before these agents can be recommended for use.
Roberts
Derek J
DJ
Faculty of Medicine, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
Banh
Hoan Linh
HL
Hall
Richard I
RI
D000328:Adult; D016638:Critical Illness; D005765:Gastrointestinal Agents / Q000494:pharmacology*; D005769:Gastrointestinal Motility / Q000187:drug effects*; D006801:Humans; D007211:Indoles / Q000494:pharmacology*; D010421:Pentanoic Acids / Q000494:pharmacology*; D010880:Piperidines / Q000494:pharmacology*
D005765:Gastrointestinal Agents; D007211:Indoles; D010421:Pentanoic Acids; D010880:Piperidines; C105050:tegaserod; C419502:alvimopan; C103490:dexloxiglumide