Abstract
OBJECTIVE: To determine the effect of the prokinetic agent cisapride in the prevention of aspiration of gastric contents. DESIGN: A prospective randomized two-period crossover study. SETTING: Fourteen-bed polyvalent intensive care unit in a University Hospital. PATIENTS: Eighteen intubated, mechanically ventilated patients who were seated in a semirecumbent position were studied. METHOD: Tc-99 m sulfur colloid (80 megabecquerels) was administered via nasogastric tube on 2 consecutive days. Patients randomly received cisapride (10 mg, via nasogastric tube) one day and a placebo the other. Bronchial secretions were obtained before and for 5 consecutive h after Tc-99 m administration. The radioactivity was measured in a standard amount (1ml) of bronchial fluid using a gamma counter and expressed as counts per min (cpm) after correction for decay. RESULTS: Sixteen out of 18 (88%) patients had increased radioactivity in bronchial secretions. The radioactivity increased over time both with and without cisapride, although it was lower in patients receiving cisapride than in those receiving a placebo. The cumulative bronchial secretion radioactivity obtained when patients received cisapride was significantly lower than when patients received a placebo: 7540 +/- 5330 and 21965 +/- 16080 cpm, respectively (P <0.05). CONCLUSION: Our results suggest that aspiration of gastric contents exists even in patients who are kept in a semirecumbent position. Moreover, cisapride decreases the amount of gastric contents aspiration in intubated and mechanically ventilated patients and may play a role in the prevention of ventilator associated pneumonia. Cisapride, even with the patient in the semirecumbent position, did not completely prevent gastric content aspiration.
Highlights
The aspiration of gastric contents induces or exacerbates bronchoconstriction and it is the most commonly recognized pathogenic factor for the development of pneumonia, especially in ventilator-associated pneumonia (VAP) [1,2].The incidence of aspiration of gastric contents is high in intensive care unit (ICU) patients and even higher in intubated and mechanically ventilated patients
There was no significant difference in baseline radioactivity of bronchial secretions whether the patients were given cisapride or placebo
Our results showed that aspiration in mechanically ventilated patients occurs even when they are kept in a semirecumbent position
Summary
The aspiration of gastric contents induces or exacerbates bronchoconstriction and it is the most commonly recognized pathogenic factor for the development of pneumonia, especially in ventilator-associated pneumonia (VAP) [1,2].The incidence of aspiration of gastric contents is high in intensive care unit (ICU) patients and even higher in intubated and mechanically ventilated patients. Additional risk factors for gastric content aspiration included enteral feeding, naso or oralgastric tubes and position of the patients. An important risk factor in causing the aspiration of gastric contents seems to be the supine position. A semirecumbent position of mechanically ventilated patients could help in part to prevent the aspiration of gastric contents into airways, but aspiration still remains a problem [7]. Orozco-Levi and colleagues [8] showed a significant increase in radioactivity count in oropharyngeal contents after Tc99m isotope instillation through nasogastric tube. This gastroesophageal reflux was irrespective of body position.
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