Mj. Chapman et al., Erythromycin improves gastric emptying in critically ill patients intolerant of nasogastric feeding, CRIT CARE M, 28(7), 2000, pp. 2334-2337
Objective: To evaluate the effect of intravenous erythromycin on gastric em
ptying and the success of enteral feeding in mechanically ventilated, criti
cally ill patients with large volume gastric aspirates.
Design: Prospective, double-blind, randomized, and placebo-controlled trial
.
Setting: General intensive care unit in a university hospital.
Patients: Twenty critically ill, mechanically ventilated patients intoleran
t of nasogastric feeding (indicated by a residual gastric volume of greater
than or equal to 250 mt during feed administration at greater than or equa
l to 40 mL/hr),
Interventions: After a gastric aspirate of greater than or equal to 250 mt,
which was discarded, the enteral feeding was continued at the previous rat
e for 3 hrs, Intravenous erythromycin (200 mg) or placebo was then administ
ered over 20 mins, The residual gastric contents were again aspirated and t
he volume was recorded 1 hr after the infusion began.
Measurements and Main Results: Gastric emptying was calculated as volume of
feed infused into the stomach over 4 hrs minus the residual volume aspirat
ed. Mean gastric emptying was 139 +/- 37 (+/-SEM) mt after erythromycin and
-2 +/- 46 mt after placebo (p = .027), Nasogastric feeding was successful
in nine of ten patients treated with erythromycin and five of ten who recei
ved placebo 1 hr after infusion (chi-square p = .05),
Conclusion: In critically ill patients who have large volumes of gastric as
pirates indicating a failure to tolerate nasogastric feeding, a single smal
l dose of intravenous erythromycin allows continuation of feed in the short
term.