Cited by 163Clinical Nutrition and GastroenterologyGastrointestinal motility and disordersEnhanced Recovery After Surgery

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The efficacy and safety of prokinetic agents in critically ill patients receiving enteral nutrition: a systematic review and meta-analysis of randomized trials

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Lewis, Kim, Alqahtani, Zuhoor, Mcintyre, Lauralyn, Almenawer, Saleh, Alshamsi, Fayez, Rhodes, Andrew, Evans, Laura, Angus, Derek C., Alhazzani, Waleed·2016·Critical Care

DOI 10.1186/s13054-016-1441-zPMC PMC4986344

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Abstract

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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Fig. 1 Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow chart. Description of the study selection processCC BY · PubMed Central

Fig. 2 Risk of bias assessment. Summary of risk of bias in individual randomized controlled trials in this systematic review; green circles low risk of bias, yellow circles unclear risk of bias, red circles indicate high risk of biasCC BY · PubMed Central

Fig. 3 Feeding intolerance outcome. Forest plot includes pooled estimates for randomized controlled trials comparing prokinetic agents to placebo or no intervention for feeding intolerance outcome. IV inverse variance, CI confidence intervalCC BY · PubMed Central

Fig. 4 High gastric residual volume (>250 ml). Forest plot includes pooled estimates for randomized controlled trials comparing prokinetic agents to placebo or no intervention for high gastric residual volume outcome. IV inverse variance, CI confidence intervalCC BY · PubMed Central

Fig. 5 Successful post-pyloric feeding tube placement. Forest plot includes pooled estimates for randomized controlled trials comparing prokinetic agents to placebo or no intervention for successful insertion of post-pyloric tube outcome. IV inverse variance, CI confidence intervalCC BY · PubMed Central

Fig. 6 ICU-acquired pneumonia outcome. Forest plot includes pooled estimates for randomized controlled trials comparing prokinetic agents to placebo or no intervention for ICU-acquired pneumonia outcome. IV inverse variance, CI confidence intervalCC BY · PubMed Central

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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
ORCID: Mcintyre, Lauralyn
Alshamsi, Fayez
Rhodes, Andrew
Evans, Laura
Angus, Derek C.
Alhazzani, Waleed
Venue: Critical Care
Publisher: Springer Science and Business Media LLC
Published: 2016-08-15
Volume: 20
Issue: 1
Pages: 259-259
ISSN: 1364-8535 (ISSN-L)
DOI: 10.1186/s13054-016-1441-z
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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The efficacy and safety of prokinetic agents in critically ill patients receiving enteral nutrition: a systematic review and meta-analysis of randomized trials

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