Evaluation of feeding intolerance in patients with pentobarbital-induced coma.
BACKGROUND
There is considerable debate regarding the appropriateness of feeding patients by the enteral route in conjunction with pentobarbital coma therapy.


OBJECTIVE
To determine the incidence of feeding intolerance (FI) in patients receiving pentobarbital in conjunction with enteral nutrition (EN).


METHODS
A retrospective, observational evaluation of patients (>14 y of age) who received a therapeutic pentobarbital coma in combination with EN was conducted. Patients were divided into groups, based on the occurrence of FI defined as aspiration of gastric residuals greater than 75 mL for 2 consecutive measurements.


RESULTS
Forty-eight percent (29 of 61) of patients experienced FI based on our definition. The median pentobarbital infusion rate did not differ significantly between patients who experienced FI versus those who did not (median [intraquartile range, IQR] 1.8 mg/kg/h [1.4, 2.1] vs 1.7 mg/kg/h [1.4, 2.5]; p = 0.680). The total pentobarbital bolus dose during the first 24 hours of therapy was lower in patients who experienced FI (700 mg [225, 980] vs 1000 mg [600, 1475]; p = 0.029). Median duration of pentobarbital therapy was comparable between groups (141.0 h [93.3, 217.3] vs 116.3 h [64.0, 174.8]; p = 0.115). Other factors with the potential to influence FI, such as catecholamines, neuromuscular blockade, and hyperglycemia, were similar between groups. The higher narcotic doses and greater percentage of patients receiving benzodiazepines in the FI group warrants further study.


CONCLUSIONS
Pentobarbital therapy did not preclude use of EN in the entire study population. In addition, FI did not occur at a greater frequency in patients who received a higher dosage, a longer duration, or an earlier initiation of pentobarbital therapy.
Stevens
Alison M
AM
Saint Louis College of Pharmacy, St. Louis, MO, USA.
Then
Janine E
JE
Frock
Karen M
KM
Crookes
Bruce A
BA
Commichau
Christopher
C
Marden
Brian T
BT
Beynnon
Bonnie J
BJ
Rebuck
Jill A
JA
D000759:Adjuvants, Anesthesia; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001930:Brain Injuries / Q000503:physiopathology* / Q000628:therapy; D003128:Coma / Q000139:chemically induced*; D016638:Critical Illness; D004750:Enteral Nutrition; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010424:Pentobarbital; D012189:Retrospective Studies
D000759:Adjuvants, Anesthesia; D010424:Pentobarbital