Esophageal motility disorders in critically ill patients: a 24-hour manometric study

Objective: Impaired tubular esophageal motility is involved in the pathogen esis of gastroesophageal reflux disease, which, in turn, has been shown to cause nosocomial pneumonia in critically ill patients. As multiple factors are involved, this pilot study was undertaken to evaluate whether, similarl y, impaired esophageal motility may contribute to nosocomial infections by determining esophageal motility in critically ill patients undergoing mecha nical ventilation and sedation in comparison to that of a healthy control g roup. Design: Open, single-centered study. Patients and methods: Fifteen co nsecutive ventilated intensive care unit (ICU) patients with different dise ases and three regimens of analgo-sedation were included: group 1: no analg o-sedation, group 2: ketamine and benzodiazepines, and group 3: fentanyl an d benzodiazepines. Six healthy volunteers were studied as controls. Twenty- four hour esophageal anterograde (propulsive) and retrograde motility chang es were assessed by a manometry system. Results: The frequencies of contrac tions were 0.67 +/- 0.1/min (no analgo-sedation) 0.093 +/- 0.02 (ketamine) and 0.076 +/- 0.01 (fentanyl) (p < 0.05 as compared to controls). The ampli tudes (% of maximum) were 98 % (control), 58 % (analgo-sedation), 38 % (ket amine) and 42 % (fentanyl; p < 0.05 for the comparison of fentanyl and keta mine with controls). Whereas the percentage of propulsive contractions was significantly decreased in patients (no sedation: 45 %, ketamine: 34 %; fen tanyl: 35 %, p < 0.05) as compared to controls (72 %), the percentage of re trograde contractions increased: no sedation: 29 %, ketamine: 34 % and fent anyl: 37 % as compared to controls: 10 %, p < 0.05. Analysis according to t he underlying diseases showed marked inhibition of motility parameters with in any disease group in comparison with controls. Conclusions: Irrespective of the underlying disease, propulsive motility of the esophageal body is s ignificantly reduced during any kind of sedation in critically ill patients . Possibly central as well peripheral drug-related effects are involved in such a depression. Twenty-four hour motility recordings appear to be a valu able and feasible method to quantify and analyze esophageal motor disorders in critically ill patients.