Delay in gastric emptying is common in the critically ill, and can lead to abdominal distension, diarrhoea or constipation, and vomiting, and may contribute to increased incidence of reflux and nosocomial infection. Prokinetic agents increase the rate of luminal transit as well as the force of contraction, and are commonly used in the intensive care unit. This article summarises the current state of knowledge about the use of prokinetics and explores potential agents which might be used in the future in this group of patients.
ZalogaGP. Early enteral nutritional support improves outcome: hypothesis or fact?Crit Care Med1999;27: 259–61.
2.
DohertyWLWinterB. Prokinetic agents in critical care. Crit Care2003;7: 206–08.
3.
MiskovitzP. Gastric prokinetic motility therapy to facilitate early enteral nutrition in the intensive care unit. Crit Care Med2002;30: 1386–87.
4.
MaykelJBistrianBR. Is enteral feeding for everyone?Crit Care Med2002;30: 714–16.
5.
HawkyardCVKoernerRJ. The use of erythromycin as a gastrointestinal prokinetic agent in adult critical care: benefits versus risks. J Antimicrob Chemother2007;59: 347–58.
6.
BoothCMHeylandDKPatersonWG. Gastrointestinal promotility drugs in the critical care setting: a systematic review of the evidence. Crit Care Med2002;30: 1429–35.
7.
ChapmanMJNyugenNQFraserRJ. Gastrointestinal motility and prokinetics in the critically ill. Curr Opin Crit Care2007;13: 187–94.
8.
YavagalDRKarnadDROakJL. Metoclopramide for preventing pneumonia in critically ill patients receiving enteral tube feeding: a randomised controlled trial. Crit Care Med2000;28: 1408–11.
9.
JoosteCAMustoeJColleeG. Metoclopramide improves gastric motility in critically ill patients. Intensive Care Med1999;25: 464–68.
10.
CalcroftRMJoyntGHungV. Gastric emptying in critically ill patients: a randomised, blinded, prospective comparison of metoclopramide with placebo. Intensive Care Med1997;23:Suppl,S138.
11.
MaclarenRWardDPHallRIComparison of cisapride and metoclopramide for facilitating gastric emptying and improving tolerance to intragastric enteral nutrition in critically ill, mechanically ventilated adults. Clin Therapeut2001;23: 1855–66.
12.
TishermanSAMarikP. Promoting enteral feeding 101. Crit Care Med2002;30: 1653–54.
13.
DiveAGalantiCJamartJEffect of erythromycin on gastric motility in mechanically ventilated critically ill patients: a double-blind, randomized, placebo-controlled study. Crit Care Med1995;23: 1356–62.
14.
ChapmanMJFraserRJKlugerMTErythromycin improves gastric emptying in critically ill patients intolerant of nasogastric feeding. Crit Care Med2000;28: 2334–37.
15.
ReignierJBensaidSPerrin-GachadoatDErythromycin and early enteral nutrition in mechanically ventilated patients. Crit Care Med2002;30: 1237–41.
16.
BerneJDNorwoodScottHErythromycin reduces delayed gastric emptying in critically ill trauma patients: a randomized, controlled trial. J Trauma2002;53: 422–25.
17.
MacLarenRKuhlDAGervasioJMSequential single doses of cisapride, erythromycin, and metoclopramide in critically ill patients intolerant to enteral nutrition: a randomized, placebo-controlled, crossover study. Crit Care Med2000;28: 438–44.
18.
RitzMAChapmanMJFraserRErythromycin dose of 70 mg accelerates gastric emptying as effectively as 200 mg in the critically ill. Intensive Care Med2005;31: 949–54.
19.
AsaiT. How should we use prokinetic drugs in patients who are intolerant to enteral feeding?Crit Care Med2007;35: 483–89.
20.
NguyenNQChapmanMFraserRProkinetic therapy for feed intolerance in critical illness: one drug or two?Crit Care Med2007;35: 2561–57.
21.
HerschMKrasilnikovVEinavSProkinetics effect on gastric emptying in critically ill ventilated patients measured by the C13 breath test with a novel device. Crit Care2007;11: 146–47.
22.
NyugenNQChapmanMJFraserRJErythromycin is more effective than metoclopramide in the treatment of feed intolerance in critical illness. Crit Care Med2007;35: 483–89.
23.
Dall'AntoniaMWilksMCoenPGErythromycin for prokinesis: imprudent prescribing?Crit Care2006;10: 112.
24.
NguyenNQChingKFraserRRisk of Clostridium difficile diarrhoea in critically ill patients treated with erythromycin-based prokinetic therapy for feed intolerance. Intensive Care Med2008;34: 169–74.
StephensD P. A clinical audit of the efficacy of tegaserod as a prokinetic agent in the intensive care unit. Crit Care Resuscitation2007;9: 148–50.
27.
CremoninFCamilleriMMcKinzieSEffect of CCK-1 antagonist, dexloxiglumide in female patients with irritable bowel syndrome: a pharmacodynamic and pharmacogenomic study. Am J Gastroenterology2005;100: 652–63.
28.
PoitrasPPolvinoWJRocheleauB. Gastrokinetic effect of ghrelin analog RC-1139 in the rat: Effect on post-operative and on morphine induced ileus. Peptides2005;26: 1598–601.
29.
TackJPeetersT. What comes after macrolides and other motilin stimulants?Gut2001;49: 317–18.
30.
PaulsonDMKennedyDTDonovickRAAlvimopan: an oral, peripherally acting, mu-opioid receptor antagonist for the treatment of opioid-induced bowel dysfunction – a 21-day treatment-randomized clinical trial. J Pain2005;6: 184–92.
31.
BalsamaLWeeseJ, Alvimopan: a peripheral acting μ-opioid-receptor antagonist used for the treatment of postoperative ileus. Therapy2007;4: 653–64.
32.
RobertsDJBanhHLHallRI. Use of novel prokinetic agents to facilitate return of gastrointestinal motility in adult critically ill patients. Curr Opin Crit Care2006;12: 295–302.
33.
TamionFHamelinKDufloAGastric emptying in mechanically ventilated critically ill patients: effect of neuromuscular blocking agentIntensive Care Med2003;29: 1717–22.
34.
HeylandDKDhaliwalRDroverJWCanadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN2003;27: 355–73.
35.
LandzinskiJKiserTFishDGastric motility function in critically ill patients tolerant vs intolerant to gastric nutrition. JPEN2008;32: 45–50.
36.
NguyenNQChapmanMFraserRThe effects of sedation on gastric emptying and intra-gastric meal distribution in critical illness. Intensive Care Med2008;34: 454–60.
37.
QuigleyEMM. Critical care dysmotility: abnormal foregut motor function in the ICU/ITU patient. Gut2005;54: 1351–52.
