The efficacy and safety of prokinetic agents in critically ill patients receiving enteral nutrition: a systematic review and meta-analysis of randomized trials
Open accessAbstract
BACKGROUND: Intolerance to enteral nutrition is common in critically ill adults, and may result in significant morbidity including ileus, abdominal distension, vomiting and potential aspiration events. Prokinetic agents are prescribed to improve gastric emptying. However, the efficacy and safety of these agents in critically ill patients is not well-defined. Therefore, we conducted a systematic review and meta-analysis to determine the efficacy and safety of prokinetic agents in critically ill patients. METHODS: We searched MEDLINE, EMBASE, and Cochrane Library from inception up to January 2016. Eligible studies included randomized controlled trials (RCTs) of critically ill adults assigned to receive a prokinetic agent or placebo, and that reported relevant clinical outcomes. Two independent reviewers screened potentially eligible articles, selected eligible studies, and abstracted pertinent data. We calculated pooled relative risk (RR) for dichotomous outcomes and mean difference for continuous outcomes, with the corresponding 95 % confidence interval (CI). We assessed risk of bias using Cochrane risk of bias tool, and the quality of evidence using grading of recommendations assessment, development, and evaluation (GRADE) methodology. RESULTS: Thirteen RCTs (enrolling 1341 patients) met our inclusion criteria. Prokinetic agents significantly reduced feeding intolerance (RR 0.73, 95 % CI 0.55, 0.97; P = 0.03; moderate certainty), which translated to 17.3 % (95 % CI 5, 26.8 %) absolute reduction in feeding intolerance. Prokinetics also reduced the risk of developing high gastric residual volumes (RR 0.69; 95 % CI 0.52, 0.91; P = 0.009; moderate quality) and increased the success of post-pyloric feeding tube placement (RR 1.60, 95 % CI 1.17, 2.21; P = 0.004; moderate quality). There was no significant improvement in the risk of vomiting, diarrhea, intensive care unit (ICU) length of stay or mortality. Prokinetic agents also did not significantly increase the rate of diarrhea. CONCLUSION: There is moderate-quality evidence that prokinetic agents reduce feeding intolerance in critically ill patients compared to placebo or no intervention. However, the impact on other clinical outcomes such as pneumonia, mortality, and ICU length of stay is unclear.
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Monitoring of established enteral nutrition with continued measurements of gastric residual volume may not be necessary.
“However, monitoring of established EN with continued measurements of GRV may not be necessary (112).”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [112]
The Discussion reports that prokinetic agents improved high gastric residual volumes, and the Results describe trials that measured them. Neither section addresses whether continued GRV monitoring is necessary once enteral nutrition is established (searched for routine monitoring and stopping GRV checks). (LLM, conf=0.72)
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Feeding Intolerance—A Key Factor in the Management of Acute Pancreatitis: A Review
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- Authors
- Lewis, K., Alqahtani, Z., Mcintyre, L., Almenawer, S., Alshamsi, F., Rhodes, A., Evans, L., Angus, D. C., & Alhazzani, W.
- Affiliations
- McMaster University (CA)
- University of Ottawa (CA)
- United Arab Emirates University (AE)
- St George's Hospital (GB)
- New York University (US)
- University of Pittsburgh (US)
- St. Joseph’s Healthcare Hamilton (CA)
- Corresponding author
- Alhazzani, Waleed
- Venue
- Critical Care
- Published
- 2016-08-15
- Volume
- 20
- Issue
- 1
- Pages
- 259-259
- ISSN
- 1364-8535 (ISSN-L)
- PMC
- PMC4986344
- OpenAlex
- W2514961948
- Cited by
- 163
- References
- 65
- Citations by year
- 2026: 19 · 2025: 15 · 2024: 11 · 2023: 14 · 2022: 16 · 2021: 22 · 2020: 26 · 2019: 20 · 2018: 9 · 2017: 9 · 2016: 2
- FWCI
- 1.78
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Critical Care (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- uO Research (University of Ottawa) (submittedVersion, public-domain)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- prokinetic agents, enteral nutrition, critically ill patients, feeding intolerance, gastric emptying, gastric residual volume, vomiting, diarrhea, ICU length of stay, mortality
- MeSH terms
- Diarrhea, Domperidone, Enteral Nutrition, Erythromycin, Gastric Emptying, Humans, Intensive Care Units, Length of Stay, Metoclopramide, Residual Volume, Vomiting, Chi-Square Distribution, Critical Illness, Dopamine Antagonists
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