Current and future therapeutic prokinetic therapy to improve enteral feed intolerance in the ICU patient.
Malnutrition is associated with poor outcomes in critically ill patients, and providing enteral feeding to those who cannot eat is considered best practice. Enteral feeding is often unsuccessful when there is delayed gastric emptying. Recent research has given additional insight into the mechanisms underlying delayed gastric emptying. Pharmacological strategies to improve the success of feeding include prokinetic drugs such as metoclopramide and erythromycin alone or in combination. When drug treatment fails, either parenteral nutrition or direct small intestinal feeding is indicated. Simpler methods to access the duodenum and distal small bowel for feed delivery are under investigation. This review summarizes current understanding of the mechanisms underlying enteral feeding intolerance in critical illness, together with the evidence for current treatment practices. Areas requiring further research are also described.
Repatriation General Hospital, Daws Road, Daw Park, Adelaide 5041, South Australia. robert.fraser@health.sa.gov.au
Robert J L
RJ
Fraser
Laura
L
Bryant
D016638:Critical Illness; D004750:Enteral Nutrition / Q000009:adverse effects*; D004917:Erythromycin / Q000627:therapeutic use; D005746:Gastric Emptying / Q000502:physiology*; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D005767:Gastrointestinal Diseases / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D005769:Gastrointestinal Motility / Q000502:physiology; D006801:Humans; D007362:Intensive Care Units; D044342:Malnutrition / Q000517:prevention & control; D008787:Metoclopramide / Q000627:therapeutic use; D010288:Parenteral Nutrition
D005765:Gastrointestinal Agents; D004917:Erythromycin; D008787:Metoclopramide