The effect of lactulose on tolerance of gastric feeding in long term ICU patients

Introduction

Lactulose was reported to inhibit gastric tone and motility in healthy volunteers [1]. Double blind placebo controlled study using lactulose four times 15 ml daily (ie 40 g) or saline for prevention of ventilator associated pneumonia was performed in our ICU during 1999-2000. In this report the impact on gastric feeding tolerance of lactulose given into stomach is evaluated.

Materials and methods

Forty-eight patients without pneumonia and mechanically ventilated for < 24 hours entered the study. From day 2 EN was given by a standardised protocol into the stomach. Daily amount of enteral nutrition (EN) was recorded. Failure was defined as EN interruption > 24 hours because of large residuals. Metoclopramide was used in all patients.

Statistics

Chi-square and Mann-Whitney U-tests when appropriate. Data presented as means ± SD. P < 0.05 was considered significant.

Results

Thirty-eight patients in whom EN was not contraindicated and stayed in the ICU > 3 days were analysed. Fifteen patients received lactulose (L) and 23 were given placebo (P). L and P groups did not differ in age (50.3 ± 18.2 and 52.7 ± 16.3; NS), APACHE II on admission (24.7 ± 8.7 and 26.0 ± 7.3; NS). There also was no difference in L and P groups in mortality (6 ICU survivors and 9 non-survivors in lactulose group and 13 non-survivors and 10 survivors in placebo group; NS), length of ICU stay (LOS) (13.5 ± 7.4 and 15.2 ± 11.0; NS) and ventilatory days (12.5 ± 6.8 and 12.0 ± 7.8; NS). Patients receiving L did not differ from P in daily tolerance of gastric feeding (604 ± 438 and 425 ± 264 ml/day; P = 0.16) and number of EN intolerances per hospitalisation (0.51 ± 0.26 and 0.50 ± 0.35 intolerances/LOS; NS). This was also true when ICU survivors were analysed separately.

Conclusions

Lactulose administered into the stomach has no impact on poor tolerance of gastric feeding in mechanically ventilated long term ICU patients.

Supported by IGA grant of Ministry of Health of the Czech Republic No. 4702-3