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Curr Opin Crit Care. 2019 Aug;25(4):349-355. doi: 10.1097/MCC.0000000000000634.

Any news from the prokinetic front?

Author information

1
Intensive Care Unit, Royal Melbourne Hospital.
2
Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria.
3
Intensive Care Unit, Royal Adelaide Hospital.
4
Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia.

Abstract

PURPOSE OF REVIEW:

This review provides an update of recently conducted studies and randomized controlled trials evaluating prokinetic drugs.

RECENT FINDINGS:

Prokinetic drugs accelerate gastric emptying and, particularly in patients with gastric dysmotility and enteral feed intolerance, their use increases the delivery of enteral nutrition. However, prokinetic drugs have not been shown to improve patient-centered outcomes in trials but benefit is assumed on the basis of observational studies, which report close associations between gastric dysmotility, enteral feed intolerance and poor outcomes, and improvement in surrogate physiological outcomes when prokinetic drugs are administered.

SUMMARY:

It may not be feasible to establish superiority of a prokinetic drug within a randomized controlled trial with a patient-centered event as the primary outcome. The use of metoclopramide and erythromycin as prokinetic drugs is based on observations from trials measuring surrogate physiological outcomes. Randomized controlled trials of alternative drug regimens and novel prokinetic drugs have recently been completed and results outlined.

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