Abstract
Objective: Impaired gastric emptying is a common cause of delayed feeding in critically ill children. Post-pyloric feeding may help improve feeding intolerance and nutritional status and, hence, contribute to a better outcome. However, post-pyloric feeding tube insertion is usually delayed due to a technical difficulty. Therefore, prokinetic agents have been used to facilitate blind bedside post-pyloric feeding tube insertion. Metoclopramide is a potent prokinetic agent that has also been used to improve motility in adults and children admitted to intensive care units. The objective of this study was to determine the efficacy of intravenous metoclopramide in promoting the success rate of blind bedside post-pyloric feeding tube placement in critically ill children.Design: The design of this study is randomized, double blind, placebo controlled.Setting: The setting of the study is a single-center pediatric intensive care unit.Patients: Children aged 1 month−18 years admitted to the pediatric intensive care unit with severe illness or feeding intolerance were enrolled in this study.Intervention: Patients were randomly selected to receive intravenous metoclopramide or 0.9% normal saline solution (the placebo) prior to the tube insertion. The study outcome was the success rate of post-pyloric feeding tube placement confirmed by an abdominal radiography 6–8 h after the insertion.Measurements and Main Results: We found that patients receiving metoclopramide had a higher success rate (37/42, 88%) of post-pyloric feeding tube placement than the placebo (28/40, 70%) (p = 0.04). Patients who received sedative drug or narcotic agent showed a tendency of higher success rate (p = 0.08).Conclusion: Intravenous metoclopramide improves the success rate of blind bedside post-pyloric placement of feeding tube in critically ill children.Trial Registration: Thai Clinical Trial Registry TCTR20190821002. Registered 15th August 2019.
Highlights
Measurements and Main Results: We found that patients receiving metoclopramide had a higher success rate (37/42, 88%) of post-pyloric feeding tube placement than the placebo (28/40, 70%) (p = 0.04)
Malnutrition is a common problem in critically ill patients causing increased morbidity and mortality [1, 2], and enteral feeding is the preferred route of nutritional support to improve nutritional status for most critically ill patients with an adequate gastrointestinal function [1, 3]
We aimed to determine whether intravenous metoclopramide improved the success rate of blind bedside post-pyloric placement of feeding tube in critically ill children in a prospective, randomized, double-blind, placebo-controlled fashion
Summary
Malnutrition is a common problem in critically ill patients causing increased morbidity and mortality [1, 2], and enteral feeding is the preferred route of nutritional support to improve nutritional status for most critically ill patients with an adequate gastrointestinal function [1, 3]. Some children cannot tolerate intragastric feeding due to delayed gastric emptying, impaired motility, or carry a higher risk of aspiration or severe gastroesophageal reflux, which can cause feeding postponement. Post-pyloric feeding may be preferred for patients at high risk for aspiration and feeding intolerance [4, 5]. Blind bedside post-pyloric feeding tube placement has been shown to be safe and feasible for early enteral feeding in critically ill patients [5, 9]. Studies in adults demonstrated promising results when using metoclopramide to improve a success rate of tube insertion [13, 14], but data in children are limited. We aimed to determine whether intravenous metoclopramide improved the success rate of blind bedside post-pyloric placement of feeding tube in critically ill children in a prospective, randomized, double-blind, placebo-controlled fashion
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