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

James Landzinski, PharmD^*, Tyree H. Kiser, PharmD, Douglas N. Fish, PharmD, FCCM, FCCP, Paul E. Wischmeyer, MD and Robert MacLaren, PharmD, FCCM, FCCP

From the ^* Department of Pharmacy, Georgetown University Hospital, Washington, DC; and the Department of Clinical Pharmacy, School of Pharmacy, and Department of Anesthesiology, School of Medicine, University of Colorado at Denver and Health Sciences Center, Denver, Colorado

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 rob.maclaren{at}uchsc.edu.

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 (AUC_0-60) 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 AUC_0-60 (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 AUC_0-60 (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.

Journal of Parenteral and Enteral Nutrition, Vol. 32, No. 1, 45-50 (2008)
DOI: 10.1177/014860710803200145


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