Prokinetic drugs for feed intolerance in critical illness: current and potential therapies.
Studies consistently show that nasogastric nutrition delivers only about 60% of nutritional goals in critically ill patients. The predominant reason is abnormal gastric motility, leading to delayed gastric emptying, which is evident clinically as large gastric residual volumes. Delayed gastric emptying occurs in about 50%-60% of critically ill patients who are fed enterally and can result in malnutrition. Furthermore, delayed gastric emptying may increase the risk of aspiration of gastric contents. Recent research has improved our understanding of the complex abnormalities of gastric motor function that underlie delayed gastric emptying in the critically ill. Feed intolerance can be treated with prokinetic drugs and/or by the placement of postpyloric feeding catheters. The place of prokinetic agents in the treatment of feed intolerance is as yet unclear, but current evidence supports the administration of erythromycin combined with metoclopramide as first-line therapy. Other novel drugs, such as methylnaltrexone, mitemcinal, ghrelin agonists and dexloxiglumide, have potential advantages over these agents but require further investigation before widespread clinical use.
Deane
Adam M
AM
Discipline of Anaesthesia and Intensive Care, University of Adelaide, Adelaide, SA. adam.deane@adelaide.edu.au
Fraser
Robert J
RJ
Chapman
Marianne J
MJ
D000932:Antiemetics / Q000627:therapeutic use; D002766:Cholecystokinin / Q000037:antagonists & inhibitors; D016638:Critical Illness; D018492:Dopamine Antagonists / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004750:Enteral Nutrition / Q000009:adverse effects; D004917:Erythromycin / Q000627:therapeutic use; D005746:Gastric Emptying / Q000502:physiology*; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D054439:Ghrelin / Q000627:therapeutic use; D006801:Humans; D008787:Metoclopramide / Q000627:therapeutic use; D009037:Motilin / Q000819:agonists; D017450:Receptors, Opioid, mu / Q000037:antagonists & inhibitors; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use
D000932:Antiemetics; D018492:Dopamine Antagonists; D005765:Gastrointestinal Agents; D054439:Ghrelin; D017450:Receptors, Opioid, mu; D017366:Serotonin Receptor Agonists; D009037:Motilin; D004917:Erythromycin; D002766:Cholecystokinin; D008787:Metoclopramide