Volume 32, Issue 1 p. 45-50
Original Communication

Gastric Motility Function in Critically Ill Patients Tolerant vs Intolerant to Gastric Nutrition

James Landzinski PharmD

James Landzinski PharmD

Department of Pharmacy, Georgetown University Hospital, Washington, DC

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Tyree H. Kiser PharmD

Tyree H. Kiser PharmD

Department of Clinical Pharmacy, School of Pharmacy

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Douglas N. Fish PharmD, FCCM, FCCP

Douglas N. Fish PharmD, FCCM, FCCP

Department of Clinical Pharmacy, School of Pharmacy

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Paul E. Wischmeyer MD

Paul E. Wischmeyer MD

Department of Anesthesiology, School of Medicine, University of Colorado at Denver and Health Sciences Center, Denver, Colorado

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Robert MacLaren PharmD, FCCM, FCCP

Corresponding Author

Robert MacLaren PharmD, FCCM, FCCP

Department of Clinical Pharmacy, School of Pharmacy

Correspondence: Robert MacLaren, PharmD, FCCM, FCCP, School of Pharmacy, University of Colorado at Denver and Health Sciences Center, 4200 East Ninth Avenue, C238, Denver, CO 80262. Electronic mail may be sent to [email protected].Search for more papers by this author
First published: 01 January 2008
Citations: 67

Abstract

Background: Administration of gastric enteral nutrition (EN) in the intensive care unit (ICU) is commonly impeded by high gastric residual volumes (GRV). This study evaluated gastric emptying in patients with limited GRV (tolerant group) vs volumes ≥150 mL (intolerant group) and whether prokinetic therapy improves gastric motility in intolerant patients. Methods: To assess gastric motility, mechanically ventilated patients received acetaminophen 975 mg, and peak plasma concentration (Cmax), concentration at 60 minutes (C60), time to Cmax (Tmax), and area under the concentration-time curve from 0 to 60 minutes (AUC0-60) were determined. This evaluation was repeated in intolerant patients after 24 hours of either erythromycin 250 mg or metoclopramide 10 mg therapy, both administered intravenously every 6 hours. Results: Ten tolerant and 20 intolerant patients were studied. Tolerant patients had significantly greater Cmax (14.12 ± 7.25 vs 9.28 ± 5.22 mg/L; p < .05), C60 (9.62 ± 4.65 vs 6.08± 4.00 mg/L; p < .001), and AUC0-60 (10.01± 5.97 vs 3.93 ± 2.84 mg/h/L; p < .01) and shortened Tmax (0.81 ± 0.61 vs 1.98 ± 1.26 hours; p < .001) compared with intolerant patients. After prokinetic therapy, Cmax (15.26 ± 8.85 mg/L), C60 (11.96 ± 5.99 mg/L), and AUC0-60 (10.90 ± 6.57 mg/h/L) increased and Tmax (1.07 ± 1.01 hours) decreased in the intolerant group to values similar to the tolerant group. Conclusions: ICU patients with elevated GRV during gastric EN have delayed gastric motility. Initiating prokinetic therapy accelerates gastric emptying to resemble that of ICU patients tolerating EN.