Do we need new prokinetics to reduce enteral feeding intolerance during critical illness?

Arthur Raymond Hubert Van Zanten

doi:10.1186/s13054-016-1466-3

Abstract

Gastrointestinal feeding intolerance and critical illness-associated gastric motility dysfunction are common. Although recent guidelines recommend not interrupting gastric feeding when gastric residual volume (GRV) is lower than 500 mL or to completely abandon measurement of GRV, it may seem that the relevance of prokinetics is reduced.In patients at risk for aspiration and in multimodal strategies to enhance feeding performance, however, use of prokinetics is still advocated. Metoclopramide and erythromycin are commonly used promotility agents, although with relevant side effects.Potential targets for new agents and early study results are addressed.

Highlights

Gastrointestinal feeding intolerance and critical illness-associated gastric motility dysfunction are common
Combining evidence and pragmatism American Society for Parenteral and Enteral Nutrition (ASPEN)/Society of Critical Care Medicine (SCCM) recommends gastric residual volume (GRV) not be used as part of routine care to monitor Intensive care unit (ICU) patients receiving enteral nutrition (EN)
In Critical Care Chapman and coworkers reported that camicinal (GSK962040), a novel motilin agonist, at present only available for enteral administration, accelerates gastric emptying in feed-intolerant critically ill patients compared with placebo, resulting in augmented glucose absorption and improved gastric emptying [15]

Summary

Introduction

Gastrointestinal feeding intolerance and critical illness-associated gastric motility dysfunction are common. Administration should be diverted lower in the gastrointestinal tract (post-pyloric feeding) in patients at high risk for aspiration or in case of gastric EN intolerance [4].

Results

Conclusion