Cisapride decreases gastric content aspiration in mechanically ventilated patients

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 Hospit al. Patients: Eighteen intubated, mechanically ventilated patients who were sea ted in a semirecumbent position were studied. Method: Tc-99m sulfur colloid (80 megabecquerels) was administered via naso gastric tube on 2 consecutive days. Patients randomly received cisapride (1 0 mg, via nasogastric tube) one day and a placebo the other. Bronchial secr etions were obtained before and for 5 consecutive h after Tc-99m administra tion. The radioactivity was measured in a standard amount (1 ml) of bronchi al 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 br onchial secretions. The radioactivity increased over time both with and wit hout cisapride, although it was lower in patients receiving cisapride than in those receiving a placebo. The cumulative bronchial secretion radioactiv ity obtained when patients received cisapride was significantly lower than when patients received a placebo: 7540 +/- 5330 and 21965 +/- 16080 cpm, re spectively (P < 0.05). Conclusion: Our results suggest that aspiration of gastric contents exists even in patients who are kept in a semirecumbent position. Moreover, cisapr ide decreases the amount of gastric contents aspiration in intubated and me chanically ventilated patients and may play a role in the prevention of ven tilator associated pneumonia. Cisapride, even with the patient in the semir ecumbent position, did not completely prevent gastric content aspiration.