Prokinetics effect on gastric emptying in critically ill ventilated patients measured by the C13 breath test with a novel device

Introduction

Gastroparesis in critically ill ventilated patients is relieved by prokinetics. The best prokinetic combination is not known and may be identified by BreathID measurement of gastric emptying (GE).

Methods

A prospective crossover study in stable ventilated ICU patients without upper gastrointestinal pathology. GE measurement: 4-hours expiratory ¹³CO₂ recording following intragastric administration of C¹³sodium acetate in 100 ml Osmolite. Baseline measurement (BM) and following 24 hours i.v. therapy with: metoclopramide (10 mg every 6 hours), metoclopramide with continuous erythromycin (10 mg/hour), continuous erythromycin and bolus erythromycin (200 mg every 12 hours) were done in each patient. The BM and drug administration order was altered in a subgroup of patients. GE was assessed by calculating the percentage dose recovered (PDR), a measure of delta over baseline reflecting the rate of substrate metabolized. The ¹³CO₂ measurements and calculations were done by our BreathID Computerized system (BreathID Ltd, Jerusalem, Israel) with its sensor attached to the expiratory ventilator tubing.

Results

Thirty-one patients were included. Figure 1 shows the PDR of all patients under the different prokinetic drugs. Table 1 presents the average percentage of GE improvement over BM with different therapies, and the average improvement of individuals' best combination. Comparing 20 patients, BM first, with 11 at different timings, revealed no difference of baseline or best combination (P = 0.1, P = 0.2, respectively).

Table 1 (abstract P146)

Figure 1

(abstract P146)

Conclusion

In this population: 1. Metoclopramide is poor in improving GE. 2. The combination of metoclopramide and continuous erythromycin is the most effective. 3. The BreathID is a convenient and novel way to monitor GE in order to study and individually tailor the most effective (up to 85% over BM) prokinetic combination.