• H D Spapen, L Duinslaeger, M Diltoer, R Gillet, A Bossuyt, and L P Huyghens.
• Department of Intensive Care Medicine, University Hospital, Vrije Universiteit Brussel, Belgium.
• Crit. Care Med. 1995 Mar 1; 23 (3): 481-5.

ObjectiveTo investigate the effect of cisapride, a relatively new prokinetic agent, on gastric emptying in critically ill patients.DesignProspective, randomized, controlled study.SettingAdult medical/surgical intensive care unit in a university hospital.PatientsTwenty-one consecutively enrolled patients, requiring prolonged mechanical ventilation and enteral feeding.InterventionsPatients were randomized to receive either no cisapride or 10 mg of cisapride four times daily, which was added to a standard enteral nutrition feeding protocol.Measurements And Main ResultsGastric emptying was evaluated by daily measurements of gastric residue and on days 5 through 7 by bedside scintigraphy. Normal values for gastric clearance of a tracer-labeled test meal and for measurements obtained in the supine position were determined in ten healthy volunteers. The mean time at which 50% of the technetium 99m-labeled test meal was eliminated from the stomach (T 1/2) in this control group was 31 +/- 15 mins. In ten critically ill patients (enteral nutrition group), gastric emptying was markedly delayed after 5 to 7 days of enteral feeding (mean T 1/2 = 78 +/- 40 mins; p < .002 as compared with the control group). In contrast, patients treated with cisapride (cisapride group) showed an accelerated gastric emptying (mean T 1/2 = 18 +/- 7 mins; p > .05 as compared with controls; p < .005 as compared with enteral nutrition group). The mean gastric residue over a 1-wk period was also significantly lower in the cisapride group than in the enteral nutrition group (17.7 +/- 8.9 vs. 94.5 +/- 33.4 mL; p < .001).ConclusionsThe data indicate that gastric emptying in critically ill, sedated, and mechanically ventilated patients can be significantly improved by adding cisapride to a routine enteral feeding protocol.

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