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Gastric emptying in the critically ill patient
1Intensive Care Unit, The Geelong Hospital, Geelong, Victoria. charliec@BarwonHealth.org.au
Summary
Gastric dysmotility is common in critically ill patients, hindering enteral nutrition. Addressing underlying causes and using prokinetic agents like cisapride or erythromycin can enable successful feeding.
Area of Science:
- Critical Care Medicine
- Gastroenterology
- Clinical Nutrition
Background:
- Gastric dysmotility is a frequent complication in critically ill patients.
- This condition often impedes the timely initiation and efficacy of enteral nutrition.
- While jejunal feeding bypasses gastric issues, its insertion can be challenging.
Purpose of the Study:
- To review the pathophysiology of gastroparesis.
- To present a practical management approach for gastroparesis in critically ill patients.
Main Methods:
- Review of articles and published abstracts on gastroparesis mechanisms and management.
- Focus on relevance to the critically ill patient population.
Main Results:
- Gastric dysmotility is multifactorial, influenced by sepsis, pain, hypotension, dehydration, and hyperglycemia.
- Avoidance of opiates and dopamine is recommended before prokinetic therapy.
- Prokinetic agents like cisapride or erythromycin, along with head elevation, can facilitate enteral feeding.
Conclusions:
- Gastric dysmotility is prevalent in critically ill patients.
- Effective management involves treating underlying conditions and employing prokinetic agents.
- Successful enteral nutrition is achievable for most patients with appropriate interventions.