Metoclopramide improves gastric motility in critically ill patients

Objective: To assess the effect of metoclopramide on gastric motility in cr itically ill patients. Design: Prospective, controlled, single-blind cross-over trial. Setting: A 10-bed general intensive care unit. Patients: Ten critically ill, enterally fed adult patients without renal fa ilure. Interventions: Each patient received enteral feeding with Enrich via a naso gastric tube at 50 ml/h throughout the 5-h study period on two consecutive days. Either normal saline (control) or 10 mg of metoclopramide (treatment) was administered intravenously at the start of the study period in random order with cross-over design. Measurements ann results: Gastric motility was measured indirectly by analy sis of the absorption over time of 1.5 g of paracetamol administered into t he stomach at the start of the study period together with a 100 ml bolus of Enrich feed. The rate of gastric emptying is proportional to the area unde r the line plot of serum paracetamol concentration against time over 120 mi n (AUC120). Eight of the ten patients studied showed an increased AUC120 wi th metoclopramide compared to that with saline. Statistical analysis with t he Wilcoxon signed rank test gave ap value of 0.04, indicating a significan t increase in gastric emptying following administration of metoclopramide. Conclusions: The administration of Intravenous metoclopramide improved gast ric emptying in a heterogeneous group of critically ill patients. Metoclopr amide is a useful prokinetic drug in this patient population.