ERYTHROMYCIN FACILITATES POSTPYLORIC PLACEMENT OF NASODUODENAL FEEDING TUBES IN INTENSIVE-CARE UNIT PATIENTS - RANDOMIZED, DOUBLE-BLINDED, PLACEBO-CONTROLLED TRIAL

Background: To determine whether administration of erythromycin (E) co uld facilitate passage of a nasoenteric feeding tube into the duodenum for postpyloric feedings, this randomized, double-blind, placebo-cont rolled trial was performed. Methods: Fifty-seven patients were accrued from the surgical intensive care units (ICUs) of a tertiary-care univ ersity hospital. Patients enrolled were categorized as to the presence or absence of diabetes mellitus (DM). Those patients without DM were then subdivided into those with normal or depressed mental status. The three groups, normal (NMS), depressed mental status (DMS), or diabete s mellitus (DM), were then randomized independently to receive either E or placebo (P), followed by blind placement of a feeding tube. Tube placement was verified by an abdominal radiograph. Results: Overall, t he rate of postpyloric placement was 61% (19/31) in the E group, signi ficantly better than 35% (9/26) in the P group (p < .05). In patients with NMS, the success rate with E was improved (64%, 9/14) compared wi th that with P (9%, 1/11) (p < .0005). In the DMS group, there was a 5 0% success rate (6/ 12)with E versus 63% (5/8) with P (not significant [NS]). In the DM group, 80% (4/5) of the patients had placement of th e tube in the duodenum with E and 43% (3/7) with P (NS). Conclusions: These data suggest that, overall, E is effective in facilitating place ment of a nasoenteric feeding tube into the duodenum in ICU patients. It is clearly beneficial in those patients with normal mental status a nd may be useful in patients with diabetes mellitus.