Am. J. Respir. Crit. Care Med., Vol 154, No. 6, Dec 1996, 1678-1683.
Cisapride improves gastric emptying in mechanically ventilated, critically ill patients. A randomized, double-blind trial
DK Heyland, G Tougas, DJ Cook and GH Guyatt
Department of Medicine, St. Joseph's Hospital, Hamilton, Ontario, Canada.
We conducted a randomized, double-blind, placebo-controlled trial in
mechanically ventilated intensive care unit (ICU) patients to evaluate the
effect of cisapride on gastric emptying using an acetaminophen absorption
model. We enrolled 72 patients expected to remain in the ICU for more than
48 h; 39% were female; the average age was 54.0 +/- 19.1 yr; 47% were
postoperative, 83% were receiving narcotics, and the mean simplified acute
physiology score (SAPS) was 9.5 +/- 3.0. Within 72 h of admission to ICU,
1.6 g of acetaminophen suspension was administered via a nasogastric tube
into the stomach (Day 1). Blood samples were drawn at baseline, 30, 60, 90,
120, and 180 min for measurement of plasma acetaminophen levels. The
following morning (Day 2), patients were randomized to receive 20 mg of
cisapride or placebo and gastric emptying was again assessed. The
difference (Day 2-Day 1) in the maximal plasma concentration was 49.1
mumol/L in the cisapride groups compared with 12.3 mumol/L in the placebo
group (p = 0.005) and the time to reach maximal concentration was
significantly shorter in the cisapride group (-40.8 min versus -4.2 min, p
= 0.02). The difference in area under the time-acetaminophen concentration
curve was also greater in the patients receiving cisapride (5,534 versus
2,832, p = 0.09). We conclude that cisapride enhances gastric emptying in
critically ill patients. Studies to examine the effect of cisapride on
tolerance to enteral nutrition, infectious morbidity, and other clinically
important outcomes are warranted.
