Preferences on the Use of Prokinetic Agents in Adult Intensive Care Unit Patients-An International Survey

INTRODUCTION: Feeding intolerance complicates enteral nutrition in intensive care unit (ICU) patients but is poorly defined. Prokinetic agents are administered to facilitate the uptake of enteral nutrition, but preferences for their use among clinicians in ICUs are unknown.

METHODS: We conducted an international electronic survey targeting ICU doctors. The survey included 76 questions that focused on symptoms considered when assessing feeding intolerance, preferences for using prokinetic agents, and willingness to participate in a future randomised trial on prokinetic agents.

RESULTS: We received 830 responses from 17 countries, with an overall response rate of 29%. Most respondents were specialists working in mixed ICUs. Feeding intolerance was assessed by 90% of respondents in their clinical work, though only 36% considered it well defined. Gastric residual volume and vomiting were symptoms most frequently used for defining feeding intolerance. Metoclopramide was the preferred prokinetic agent (54% of respondents), followed by erythromycin (42%). Four out of five considered using combination therapy, primarily a combination of metoclopramide and erythromycin (89%). Concerns about side effects were reported for all agents, with extrapyramidal symptoms and QT prolongation being the most common across agents. The majority (91%) of respondents supported a future randomised trial comparing prokinetic agents to placebo.

CONCLUSION: This international survey found practice variations in the symptoms reportedly used to assess feeding intolerance. Metoclopramide was the preferred prokinetic agent, followed by erythromycin. Most respondents supported a future randomised trial.