Treating delayed gastric emptying in critical illness: metoclopramide, erythromycin, and bedside (cortrak) nasointestinal tube placement.

BACKGROUND

We describe experience using the Cortrak nasointestinal feeding tube and prokinetics in critically ill patients with delayed gastric emptying.

METHODS

Patient cohorts fed via a Cortrak electromagnetically guided nasointestinal tube (EGNT) or 14 French-gauge nasogastric tube plus prokinetics were retrospectively compared.

RESULTS

Of 69 EGNT placements in 62 patients, 87% reached the small intestine. The median percentage of the enteral nutrition goal increased from 19% pre-EGNT to 80%-100% between days 1 and 10 post-insertion and was greater than in 58 patients prescribed metoclopramide (40%-87%: days 1-2, 5-7, P < or = .018) or 38 patients prescribed erythromycin (48%-98%; days 1 and 5, P < .0084). Up to day 10, the cumulative feeding days lost were lower for EGNT (1.06) than for metoclopramide (2.6, P < .02) or erythromycin (3.1, P < .02). The EGNT group had a lower use of prokinetics and lower treatment cost.

CONCLUSION

Most bedside EGNT placements succeed and, compared to nasogastric feeding plus prokinetics, increase enteral nutrition delivery and reduce both cumulative feeding days lost and prokinetic use.