Table 2. Effects on gastrointestinal symptoms and feeding tolerance.
| Study | Population (sample size) | Intervention | Outcome | P Value | Conclusions |
|---|---|---|---|---|---|
| Sustic et al 2005 (Croatia) [36] | Cardiosurgical patients after CABG surgery (40) | 1) Metoclopramide 10 mg i.v.; 2) Control group: saline. |
AUC120; Cmax. 574±296; 8.51±2.2 429±309; 5.15±2.8 |
0.027; 0.007 | In CABG surgery patients with early enteral feeding, a single dose of intravenous metoclopramide effectively improves gastric emptying. |
| Nursal et al 2007 (Turkey) [29] | Traumatic brain injury patients with Glasgow Coma Scores of 3–11 (19) | 1) Metoclopramide 10 mg i.v. q8h×5 days; 2) Control group: saline. |
FI; feeding complications; AUC60 at day 5; Cmax day 5; 4/10 (40%); 5/10 (50%); 589.6±457.8; 15.8±12.9 2/9 (22.2%); 3/9 (33.3%); 560±432.9; 12.0±9.9 |
NS; NS; NS; NS | The results were unable to reveal any advantage of using metoclopramide in TBI patients. |
| Acosta-Escribano et al 2014 (Spain) [23] | Adult neuro-critical patients, Glasgow Coma Scores of 14 to 9 points (109) | 1) Metoclopramide 10 mg i.v.; 2) Placebo: saline. |
Incidence of gastrointestinal complications; Incidence of GRV>500 mL at day 5; 29/58 (50%); 16/58 (28%) 22/51 (45%); 11/51 (22%) |
NS; NS | Metoclopramide has no effect on decreasing gastrointestinal complications in adult neuro-critical patients |
| Rajan et al 2017 (India) [35] | Critically ill cirrhotic patients in a liver intensive care unit (72) | 1) Metoclopramide i.v.; 2) Erythromycin i.v.; 3) Placebo. |
Resolution of FI; decrease in GRV beyond 24 hrs; the time to restart enteral nutrition (days) 8.7%; no report; 2.61±0.72 24%; no report; 2.20±0.91 no report; no report; 3.47±1.29 |
0.026; no report; 0.03 | Early detection and the addition of prokinetics facilitate the resolution of FI in critically ill cirrhotic patients. Erythromycin is safe and superior to metoclopramide for early resolution of gut paralysis in critically ill cirrhotic patients. |
| Ritz et al 2005 (Australia) [30] | Mixed medical/surgical intensive care unit patients (35) | 1) Erythromycin 70 mg i.v.; 2) Erythromycin 200 mg i.v.; 3) Placebo, saline (0.9%). |
Gastric emptying coefficient; gastric half-emptying time (t1/2) 3.8 (3.3–4.0); 98 (88–112) min 4.0 (3.6–4.2); 86 (75–104) min 2.9 (2.5–3.7); 122 (102–190) min |
<0.05; <0.05 | Treatment with 70 and 200 mg of intravenous erythromycin is equally effective in accelerating gastric emptying in critically ill patients. Doses as low as 70 mg (approx. 1 mg/kg) accelerate gastric emptying in critically ill patients, improving the success of enteral feeding. This effect is observed only in patients with delayed gastric emptying. |
| Spapen et al 1995 (Belgium) [31] | Adult medical/surgical intensive care unit patients (21) | 1) Cisapride 10 mg q6h NG; 2) No treatment. |
Gastric residual over one week; gastric emptying time T1/2; 17.7±8.9 mL; 18±7 min 94.5±33.3 mL; 78±40 min |
<0.001; <0.005 | Gastric emptying in critically ill, sedated, and mechanically ventilated patients can be significantly improved by adding cisapride to a routine enteral feeding protocol. |
| Heyland et al 1996 (Canada) [33] | Mixed intensive care unit patients (72) | 1) Cisapride 20 mg; 2) An identical placebo. |
Differences (Day 2—Day 1) in ΔCmax; Δtmax; ΔAUC180 49.1±10.7; -40.8±12.0; 5534±1349 12.3±7.0; -4.2±10.4; 2832±769 |
0.005; 0.02; 0.09 | Cisapride enhances gastric emptying in critically ill patients |
| Chapman et al, 2016 (Australia) [24] | Mixed intensive care unit patients (33) |
1) GSK962040 (50 mg) NG; 2) GSK962040 (75 mg) NG; 3) Placebo. |
Baseline vs. post gastric emptying time BTt½; AUC240 0.65 (0.39,0.1.08); 2.50 (1.68,3.72) 1.85 (0.82,4.15); 0.72 (0.39,1.36) 1.21 (0.68,2.15); 1.33(0.85,2.06) |
No report; no report | A single enteral dose of camicinal (50 mg but not 75 mg), accelerates gastric emptying and increases glucose absorption in feeding-intolerant critically ill patients. |
| Mokhtari et al 2009 (Islamic Republic of lran) [34] | Critically ill adult respiratory distress syndrome (ARDS) patients (32) | 1) Ginger NG, 2) Placebo. |
Feeding tolerated in the first 48 hrs; feeding tolerated during the entire study period 51%; 92% 57%; 93% |
<0.005; 0.42 | Supplementing the diet with ginger extract in ARDS patients reduces the delayed gastric emptying risk. |
| Guo JH, et al 2012 (China) [26] | Mixed intensive care unit patients (80) | 1) Traditional Chinese medicine group: Chenxia Sijunzi decoction; 2) Western medicine group: mosapride dispersible tablets 5 mg and multienzyme tablets NG; 3) Control group: routine symptomatic treatment without any medicines to promote gastrointestinal function. |
The time to bowel sound recovery; the time to passage of gas by anus recovery; the time to bowel movement recovery 41.02±7.52a; 49.90±6.95a; 58.22±6.71a 44.02±6.23a; 51.32±5.12a; 60.91±3.72a 54.62±5.51; 64.68±9.47; 78.20±7.11 |
aP<0.01 | Chenxia Sijunzi decoction can promote severe patients’ gastrointestinal function recovery. No significant differences in each testing index were found between the traditional Chinese medicine and Western medicine groups. |
| Kooshki et al 2018 (Iran) [27] | Mixed intensive care unit patients (60) | 1) Fenugreek seed powder 3 g q12h NG; 2) Routine care. |
GRV at the 5th day; diarrhea; constipation; respiratory aspiration at 5th/6th days 28.06±9.23; 1/30 (3.3%); 3/30 (10%); 1/30 (3.3%) 38.94±9.54; 6/30 (20%); 21/30 (70%); 10/30 (33.3%) |
0.001; 0.04; 0.001; 0.005 | Beneficial effects of fenugreek seeds on food intolerance were observed in critically ill patients. |
| Tahershamsi et al 2018 (Iran) [37] | Mixed intensive care unit patients (50) | 1) Gastrolit (Zataria multiflora) (20 drops) q8h× 4 days; 2) Placebo = water. |
GRV on the second, third, and fourth days The data could not be extracted |
All P<0.0001 | Gastrolit can decrease the GRV in mechanically ventilated patients |
| Doi et al 2019 (Japan) [25] | Mixed intensive care unit patients | 1) Rikkunshito 5 g q8h ×5 days;2) Rikkunshito 2.5 g q8h×5 days;3) No rikkunshito (control). | GRV; the percentage of the target energy at the 5th day; the target energy was achieved at the 5th day No report; 62%; 63% No report; 40%; 38% No report; 59%; 56% |
NS; NS; NS | Standard- or high-dose rikkunshito did not improve achievement of the enteral calorie target in critically ill adults. |
FI, feeding intolerance; NS, not significant
aP<0.01 compared with the control group.