This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Scopus Google Scholar Articles by Dickerson, R. N. Articles by Brown, R. O. PubMed PubMed Citation Articles by Dickerson, R. N. Articles by Brown, R. O. Social Bookmarking                         What's this?

Disparate Response to Metoclopramide Therapy for Gastric Feeding Intolerance in Trauma Patients With and Without Traumatic Brain Injury

From the Departments of ¹ Clinical Pharmacy and² Surgery, University of Tennessee Health Science Center, and ³ Department of Pharmacy, Regional Medical Center at Memphis, Memphis, Tennessee.

Address correspondence to: Roland N. Dickerson, PharmD, BCNSP, FACN, FCCP, Department of Clinical Pharmacy, University of the Tennessee Health Science Center, 910 Madison Building, Room 308, Memphis, TN 38163; e-mail: rdickerson{at}utmem.edu.

Patients with traumatic brain injury (TBI) have delayed gastric emptying and often require prokinetic drug therapy to improve enteral feeding tolerance. The authors hypothesized that metoclopramide was less efficacious for improving gastric feeding tolerance for trauma patients with TBI compared to trauma patients without TBI. A retrospective analysis was conducted of patients admitted to the trauma or neurosurgical intensive care unit who received gastric feeding from January 2006 to April 2008. Gastric feeding intolerance was defined by a gastric residual volume >200 mL or emesis with abdominal distension or discomfort. Patients with gastric feeding intolerance were given metoclopramide 10 mg intravenously every 6 hours, followed by a dose escalation to 20 mg, and then combination therapy with metoclopramide and erythromycin 250 mg intravenously every 6 hours if intolerance persisted. In total, 882 trauma patients (49% with TBI) were evaluated. TBI patients had a higher incidence of gastric feeding intolerance than those without TBI (18.6% vs 10.4%, P .001). Efficacy rates for metoclopramide 10 mg, metoclopramide 20 mg, and metoclopramide-erythromycin were 55%, 62%, and 79%, respectively (P .03). Metoclopramide failure occurred in 54% of patients with TBI compared to 35% of patients without TBI, respectively (P .02), due to a greater prevalence of tachyphylaxis. Single-drug therapy with metoclopramide was less effective for TBI trauma patients compared to trauma patients without TBI. Combination therapy with erythromycin as first-line therapy for TBI trauma patients with gastric feeding intolerance is indicated if there are no contraindications or significant drug interactions.

Key Words: metoclopramide • erythromycin • enteral feeding • motility • trauma • traumatic brain injury

Journal of Parenteral and Enteral Nutrition, Vol. 33, No. 6, 646-655 (2009)
DOI: 10.1177/0148607109335307


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				R. MacLaren Unanswered Questions of "ProCon"etic Therapy JPEN J Parenter Enteral Nutr, November 1, 2009; 33(6): 724 - 725. [Full Text] [PDF]