Table 1 Characteristics of studies
Author | Population | Feeding intolerance at baseline | Intervention groups | Outcomes | Definition of feeding intolerance | Definition of nosocomial pneumonia | Funding |
|---|---|---|---|---|---|---|---|
Whatley 1984 USA (n = 10) | Critically ill patients who failed post-pyloric tube insertion Mean age: 46.0 years, 80.0 % male Mean APACHE II score: not reported | No | Metoclopramide 20 mg IV single dose vs no intervention | 1) Successful post-pyloric feeding tube insertion | N/A | N/A | NR |
Heiselman 1995 USA (n = 105) | Critically ill patients who required enteral nutrition Mean age: NR % male: NR Mean APACHE II: NR | No | Metoclopramide 10 mg IV vs no medication | 1) Successful post-pyloric feeding tube insertion | N/A | N/A | NR |
Kalliafas 1996 USA (n = 57) | Critically ill patients who required enteral nutrition Mean age: 57.4 years, 52.6 % male Mean APACHE II score 14.9 | No | Erythromycin 200 mg IV vs placebo | 1) Successful post-pyloric feeding tube insertion | N/A | N/A | NR |
Paz 1996 USA (n = 83) | Critically ill patients who required enteral nutrition Mean age: 60.8 years, 53.0 % male Mean APACHE II score: NR | No | Erythromycin 200 mg IV single dose vs metoclopramide 10 mg IV single dose vs placebo | 1) Successful postpyloric feeding tube insertion | N/A | N/A | Industry |
Chapman 2000 Australia (n = 20) | Critically ill, mechanically ventilated patients who failed enteral feeding Mean age: 46.3 years, 80 % male Mean APACHE II score:16.2 | Yes | Erythromycin 200 mg IV single dose vs placebo | 1) Mortality 2) Feeding intolerance | Gastric residual volume greater than or equal to 250 ml | N/A | NR |
Yavagal 2000 India (n = 305) | Critically ill patients who required a nasogastric tube for more than 24 hours Mean age: 36.5 years, 62.0 % male Mean APACHE II score: 17.7 | No | Metoclopramide 10 mg IV q8h vs placebo | 1) Mortality 2) Nosocomial pneumonia | N/A | 1) New infiltrate of chest radiograph 2) A positive tracheal or sputum culture 3) Axillary temperature greater than 38 °C 4) Leukocytosis (white cell count greater than 12,000/ml) or Leukopenia (white cell count less than 3000/ml) | NR |
Pinilla 2001 Canada (n = 80) | Critically ill patients who required enteral nutrition for 3 or more days Mean age: 52.9 years, 55.0 % male Mean APACHE II score: NR | No | Metoclopramide, cisapride or domperidone (no dose/route/frequency provided) vs no intervention | 1) Gastrointestinal intolerance 2) Vomiting 3) Gastric residual volumes 4) Diarrhea | 1) Witnessed vomiting 2) Diarrhea (3 or more liquid stools in a 24-hour period) 3) Gastric residual volume greater than 150 ml for the control group or greater than 250 mL for the treatment group | N/A | NR |
Berne 2002 USA (n = 68) | Critically ill trauma patients who had a gastric residual volume greater than 150 ml in the 1st 48 hours of feeding Mean age: 37.1 years, 84.7 % male Mean ISS: 24.2 | Yes | Erythromycin 250 mg IVq6h vs placebo | 1) Nosocomial pneumonia 2) Feeding intolerance 3) ICU length of stay 4) Mortality 5) Infectious complications | Gastric residual volumes greater than 150 ml | 1) Fever greater than 38.6 °C, 2) Leukocytosis (white blood cells greater than 10,000 cell/L) 3) Purulent sputum 4) New infiltrate on chest radiograph 5) Sputum sample showing moderate or many white blood cells and a positive culture | NR |
Reignier 2002 France (n = 40) | Critically ill patients receiving mechanical ventilation and early nasogastric feeding Mean age: 68.0 years, 50.0 % male Mean APACHE II score: NR | No | Erythromycin 250 mg IV q6h × 5 days vs D5W 50 ml IV q6h × 5 days | 1) Mortality 2) Gastric intolerance 3) Vomiting | 1) Vomiting 2) Gastric residual volume greater than 250 ml | N/A | NR |
Griffith 2003 USA (n = 36) | Critically ill patients requiring enteral nutrition and exhibiting one or more of: evidence of delayed gastric emptying with repeatedly high gastric aspirates, history of pulmonary aspiration of tube feeds, clinical high risk of aspiration, head-of-the-bed elevation not possible, or severe acute pulmonary disease Mean age: 57.2 years, 69.4 % male Mean APACHE II score: NR | Yes | Erythromycin 500 mg IV single dose vs placebo | 1) Successful post-pyloric feeding tube insertion | N/A | N/A | Academic |
Nursal 2007 Turkey (n = 19) | Critically ill patients Mean age: 43.4 years, 84.2 % male Mean APACHE II: 12.9 |  | Metoclopramide 10 mg IV TID × 5 days vs normal saline TID × 5 days | 1) Mortality 2) Aspirations 3) Feeding intolerance 4) ICU length of stay 5) Vomiting 6) Ileus 7) Diarrhea 8) Gastric residual volume 9) Extrapyramidal movement | 1) Gastric residue volume greater than twice the current hourly infusion rate, or if it was more than 150 ml 2) Abdominal distention, vomiting, or diarrhea | N/A | NR |
Nassaj 2010 (n = 220) | Critically ill patients who required a nasogastric tube for more than 24 hours Mean age: 44.0 years, 65.5 % male Mean APACHE II score: 14.9 | No | Metoclopramide 10 mg PO q8h × 5 days vs no intervention | 1) Nosocomial pneumonia 2) Mortality | N/A | 1) Axillary temperature greater than 37.5 °C 2) Leukocytosis (white blood cells greater than 11, 000 cell/L) 3) Increase in tracheal secretions (>0.4 cm3/hour) 4) New infiltrate on the chest radiograph or progression of an existing infiltrate | NR |
Hu 2015 China (n = 298) | Critically ill patients who required enteral nutrition for more than 3 days Mean age: 62.9 years, 66.1 % male Mean APACHE II score: 21.1 | No | Metoclopramide 20 mg IV (single dose) vs domperidone 20 mg QID vs no intervention | 1) Successful post-pyloric feeding tube insertion | N/A | N/A | Academic |