Nguyen et al evaluated factors affecting tolerance of enteral feeding in a critically ill patient. These can help to identify way of optimizing nutritional support in these patients. The authors are from Royal Adelaide Hospital in Australia.


Medications associated with poor tolerance:

(1) narcotic analgesia

(2) benzodiazepine


Prokinetic therapy can improve tolerance to enteral feeding

(1) combination therapy with both erythromycin and metoclopramide (combination prokinetic therapy with erythromycin 200 mg IV bid and metoclopramide 10 mg IV qd) is superior to either agent alone.

(2) monotherapy with either agent is better than no therapy at all with erythromycin better than metoclopramide. However, monotherapy rapidly loses its effectiveness.


Conditions associated with poor response to prokinetic therapy:

(1) large gastric residual volume prior to prokinetic therapy

(2) hyperglycemia

(3) high APACHE II score

(4) therapy with inotropic drugs


Hypoalbuminemia is associated with poor tolerance to enteral feeding but increases the response to prokinetic therapy.


Contraindications to enteral feeding:

(1) liver dysfunction

(2) myasthenia gravis

(3) recent gastrointestinal perforation or surgery


Contraindications to prokinetic therapy:

(1) allergy to the prokinetic agent

(2) diarrhea


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