Dr. Goldhill et al., DOUBLE-BLIND, RANDOMIZED STUDY OF THE EFFECT OF CISAPRIDE ON GASTRIC-EMPTYING IN CRITICALLY ILL PATIENTS, Critical care medicine, 25(3), 1997, pp. 447-451
Objectives: To investigate the absorption of the gastrokinetic drug, c
isapride, and effect of cisapride on gastric emptying in critically il
l patients; and to assess the usefulness of clinical signs of gastric
emptying. Design: Prospective, randomized, controlled study. Setting:
Medical/surgical/trauma intensive care unit (ICU) in a university hosp
ital. Patients: Twenty-seven consecutively enrolled patients, aged 18
to 65 yrs, with normal hepatic and renal biochemistry who were not rec
eiving enteral nutrition and who had no contraindications to enteral n
utrition. These patients were expected to stay in the ICU for at least
4 days. Interventions: Patients were randomized to receive either pla
cebo or rectal cisapride, 60 mg initially followed by two doses of 30
mg at 8-hr intervals. Measurements and Main Results: Gastric emptying
was estimated, using acetaminophen absorption on day 1 of the study. P
lacebo or cisapride was administered and a second acetaminophen absorp
tion test for gastric emptying was carried out on day 2, 24 hrs after
the first test. Four patients were excluded because of incomplete data
. Statistical analysis was performed, using the area under the acetami
nophen absorption curve from 0 to 60 mins as the primary measure of ga
stric emptying. There was no significant change in the area under the
acetaminophen absorption curve from 0 to 60 mins from day 1 to day 2 i
n patients who received placebo or cisapride. Using the combination of
the time to maximum acetaminophen concentration (less than or equal t
o 30 mins) with a maximum concentration (> 12 mg/L) to define ''normal
'' emptying, on day 1, four of the 11 placebo patients had the ''norma
l'' gastric emptying, and by day 2, five patients fulfilled this crite
rion. Before administration of cisapride, four of the 12 patients fulf
illed this criterion, whereas nine fulfilled the criterion after recei
ving cisapride. There was a large variation in gastric emptying from d
ay 1 to day 2; a power calculation suggests that similar to 150 patien
ts would have to be studied to determine the effect of cisapride. Ther
e was no correlation between gastric emptying and the volume of gastri
c aspirate or the presence of bowel sounds. Plasma cisapride concentra
tions 4 hrs after the third dose, during the second acetaminophen abso
rption test, averaged 53 ng/mL (range 20 to 111). Conclusions: Rectal
cisapride in the dose given achieved average plasma concentrations sim
ilar to those concentrations achieved in healthy subjects after 30 mg
of cisapride rectally. There is a large variation in gastric emptying
from one day to the next and large numbers of patients are required to
determine if cisapride administration improves early gastric emptying
in critically ill patients. The volume of gastric aspirate and the pr
esence of bowel sounds do not correlate with gastric emptying.