Gastric feeding with erythromycin is equivalent to transpyloric feeding in the critically ill
Abstract
OBJECTIVE: To determine whether adding erythromycin to a gastric feeding regimen could render it as effective in meeting nutritional needs as transpyloric feeding. DESIGN: Randomized, controlled study. SETTING: University hospital medical, surgical, and neurologic care intensive care units. PATIENTS: Critically ill patients, requiring a projected 96 hrs of enteral feeding, who had no specific indication for tube location (gastric or transpyloric). Eighty patients were randomized. INTERVENTIONS: Patients were randomized to gastric feeding with erythromycin (200 mg iv) given every 8 hrs or feeding through a transpylorically placed feeding tube. Goal rate and feeding advancement were determined by protocol. MEASUREMENTS AND MAIN RESULTS: During the 96-hr period, the gastric group received 74% of their goal calories and the transpyloric group received 67%. The only day on which gastric feedings were superior was the first study day, where the gastric group attained 55% of their goal, compared with 44% in the transpyloric group. This 1-day difference was the result of an initial failure of tube placement in some subjects. Exclusion of these patients did not change overall results. Nutritional indexes, length of stay in the intensive care unit, ventilator dependence, and survival were not different between the two groups. CONCLUSIONS: Gastric feeding with erythromycin as a prokinetic is equivalent to transpyloric feeding in meeting the nutritional goals of the critically ill.
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Bolus feeding could provide a greater stimulus for protein synthesis.
“Finally, bolus feeding could provide a greater stimulus for protein synthesis (84).”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [84]
Cites
Erythromycin improves gastric emptying in critically ill patients intolerant of nasogastric feeding
Chapman, M. J., Fraser, R. J., Kluger, M. T., Buist, M. D., & De Nichilo, D. J. (2000) · Critical Care Medicine · doi:10.1097/00003246-200007000-00026 · Cited by 163 · see citing works
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McClave, S. A., Taylor, B. E., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., et al. (2016) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607115621863 · Cited by 3,982 · see citing works
ESPEN guideline on clinical nutrition in the intensive care unit.
Singer, P., Blaser, A. R., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, M. P., Hiesmayr, M., Mayer, K., Montejo, J. C., Pichard, C., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.08.037 · Cited by 2,904 · see citing works
McClave, S. A., Martindale, R. G., Vanek, V. W., McCarthy, M., Roberts, P., Taylor, B., Ochoa, J. B., Napolitano, L., Cresci, G., the A.S.P.E.N. Board of Directors, et al. (2009) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607109335234 · Cited by 1,873 · see citing works
Taylor, B. E., McClave, S. A., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., et al. (2016) · Critical Care Medicine · doi:10.1097/ccm.0000000000001525 · Cited by 1,476 · see citing works
ESPEN guidelines on enteral nutrition: intensive care
Kreymann, K. G., Berger, M. M., Deutz, N. E. P., Hiesmayr, M., Jolliet, P., Kazandjiev, G., Nitenberg, G., van den Berghe, G., Wernerman, J., Ebner, C., et al. (2006) · Clinical Nutrition · doi:10.1016/j.clnu.2006.01.021 · Cited by 1,366 · see citing works
White, H., Sosnowski, K., Tran, K., Reeves, A., & Jones, M. (2009) · Critical Care · doi:10.1186/cc8181 · Cited by 103 · see citing works
- Authors
- Boivin, M. A., & Levy, H.
- Affiliations
- American Thoracic Society (US)
- University of New Mexico (US)
- ORCID
- Levy, Howard
- Venue
- Critical Care Medicine
- Published
- 2001-10
- Volume
- 29
- Issue
- 10
- Pages
- 1916-1919
- ISSN
- 0090-3493 (ISSN-L)
- OpenAlex
- W2070694912
- Cited by
- 101
- References
- 1
- Citations by year
- 2025: 2 · 2024: 2 · 2022: 2 · 2021: 2 · 2020: 1 · 2019: 2 · 2018: 1 · 2017: 1 · 2016: 7 · 2015: 3 · 2014: 5 · 2013: 4 · 2012: 3
- FWCI
- 9.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Research Resources (5M01-RR00997, M01RR000997)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Keywords
- gastric tube feeding, transpyloric feeding, erythromycin, prokinetic agents, enteral nutrition, critically ill patients, intensive care unit, tube placement, nutritional adequacy
- MeSH terms
- Critical Care, Drug Administration Schedule, Enteral Nutrition, Erythromycin, Female, Follow-Up Studies, Gastrostomy, Humans, Injections, Intravenous, Intensive Care Units, Male, Middle Aged, Nutritional Requirements, Probability, Pylorus, Sensitivity and Specificity, Chi-Square Distribution, Critical Illness, Treatment Outcome
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