Sequential single doses of cisapride, erythromycin, and metoclopramide in critically ill patients intolerant to enteral nutrition: A randomized, placebo-controlled, crossover study

Objective: To evaluate the comparative efficacy of enteral cisapride, metoc lopramide, erythromycin, and placebo for promoting gastric emptying in crit ically ill patients with intolerance to gastric enteral nutrition (EN). Design: A randomized, crossover study. Setting:Adult medical intensive care unit at a university-affiliated privat e hospital and trauma intensive care unit at a university teaching hospital . Patients: Ten adult, critically ill, mechanically ventilated patients not t olerating a fiber-containing EN product defined as a single aspirated gastr ic residual volume >150 mt or two aspirated gastric residual volumes >120 m t during a 12-hr period. Interventions: Patients received 10 mg of cisapride, 200 mg of erythromycin ethylsuccinate, 10 mg of metoclopramide, and placebo as 20 mt of sterile w ater every 12 hrs over 48 hrs. Acetaminophen solution (1000 mg) was adminis tered concurrently. Gastric residual volumes were assessed, and plasma acet aminophen concentrations were serially determined by TDx between 0 and 12 h rs to evaluate gastric emptying. Measurements and Main Results: Gastric residual volumes during the study we re not significantly different between agents. No differences in area under the concentration vs. time curve or elimination rate constant were identif ied between agents, Metoclopramide and cisapride had a significantly shorte r mean residence time of absorption than erythromycin (6.3 +/- 4.5 [SEM] mi ns and 10.9 +/- 5.8 vs. 30.1 +/- 4.5 mins, respectively [p < .05]), Metoclo pramide (9.7 +/- 15.3 mins) had a significantly shorter time to peak concen tration compared with erythromycin and placebo (60.7 +/- 8.1 and 50.9 +/- 1 3.5 mins, respectively [p < .05]), The time to onset of absorption was sign ificantly shorter for metoclopramide vs. cisapride (5.7 +/- 4.5 vs. 22.9 +/ - 5.7 mins [p < .05]), Conclusion: In critically ill patients intolerant to EN, single enteral dos es of metoclopramide or cisapride are effective for promoting gastric empty ing in critically ill patients with gastric motility dysfunction, Additiona lly, metoclopramide may provide a quicker onset than cisapride.