[Promotility drugs use in critical care: indications and limits?].
Enteral feeding is often limited by gastric and intestinal motility disturbances in critically ill patients, particularly in patients with shock. So, promotility agents are frequently used to improve tolerance to enteral nutrition. This review summaries the pathophysiology, presents the available pharmacological strategies, the clinical data, the counter-indications and the principal limits. The clinical data are poor. No study demonstrates a positive effect on clinical outcomes. Metoclopramide and erythromycin seems to be the more effective. Considering the risk of antibiotic resistance, the first line use of erythromycin should be avoided in favor of metoclopramide.
Libert
N
N
Département d'anesthésie réanimation, hôpital d'instruction des armées du Val-de-Grâce,74, boulevard de Port-Royal, 750005 Paris, France. nicolaslibert@free.fr
De Rudnicki
S
S
Cirodde
A
A
Janvier
F
F
Leclerc
T
T
Borne
M
M
Brinquin
L
L
D003422:Critical Care; D018492:Dopamine Antagonists / Q000627:therapeutic use; D004750:Enteral Nutrition; D004917:Erythromycin / Q000627:therapeutic use; D005769:Gastrointestinal Motility / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008787:Metoclopramide / Q000627:therapeutic use; D009037:Motilin / Q000819:agonists
D018492:Dopamine Antagonists; D009037:Motilin; D004917:Erythromycin; D008787:Metoclopramide