Prokinetic therapy for feed intolerance in critical illness: One drug or two?

OBJECTIVE:To compare the efficacy of combination therapy, with erythromycin and metoclopramide, to erythromycin alone in the treatment of feed intolerance in critically ill patients. DESIGN:Randomized, controlled, double-blind trial. SETTING:Mixed medical and surgical intensive care unit. PATIENTS:Seventy-five mechanically ventilated, medical patients with feed intolerance (gastric residual volume ≥250 mL). INTERVENTIONS:Patients received either combination therapy (n = 37; 200 mg of intravenous erythromycin twice daily + 10 mg of intravenous metoclopramide four times daily) or erythromycin alone (n = 38; 200 mg of intravenous erythromycin twice daily) in a prospective, randomized fashion. Gastric feeding was re-commenced and 6-hourly gastric aspirates performed. Patients were studied for 7 days. Successful feeding was defined as a gastric residual volume