Erythromycin improves gastric emptying in critically ill patients intolerant of nasogastric feeding

OBJECTIVETo evaluate the effect of intravenous erythromycin on gastric emptying and the success of enteral feeding in mechanically ventilated, critically ill patients with large volume gastric aspirates. DESIGNProspective, double-blind, randomized, and placebo-controlled trial. SETTINGGeneral intensive care unit in a university hospital. PATIENTSTwenty critically ill, mechanically ventilated patients intolerant of nasogastric feeding (indicated by a residual gastric volume of ≥250 mL during feed administration at ≥40 mL/hr). INTERVENTIONSAfter a gastric aspirate of ≥250 mL, which was discarded, the enteral feeding was continued at the previous rate for 3 hrs. Intravenous erythromycin (200 mg) or placebo was then administered over 20 mins. The residual gastric contents were again aspirated and the volume was recorded 1 hr after the infusion began. MEASUREMENTS AND MAIN RESULTSGastric emptying was calculated as volume of feed infused into the stomach over 4 hrs minus the residual volume aspirated. Mean gastric emptying was 139 ± 37 (±sem) mL after erythromycin and −2 ± 46 mL after placebo (p = .027). Nasogastric feeding was successful in nine of ten patients treated with erythromycin and five of ten who received placebo 1 hr after infusion (chi-square p = .05). CONCLUSIONIn critically ill patients who have large volumes of gastric aspirates indicating a failure to tolerate nasogastric feeding, a single small dose of intravenous erythromycin allows continuation of feed in the short term.