Intensive Care Medicine

, Volume 22, Issue 12, pp 1339–1344

Impaired gastric emptying in mechanically ventilated, critically ill patients

  • D. K. Heyland
  • G. Tougas
  • D. King
  • D. J. Cook
Original

DOI: 10.1007/BF01709548

Cite this article as:
Heyland, D.K., Tougas, G., King, D. et al. Intensive Care Med (1996) 22: 1339. doi:10.1007/BF01709548
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Abstract

Objective

To measure gastric emptying in critically ill patients using an acetaminophen absorption model and determine which variables are associated with impaired gastric emptying.

Design

A prospective, cohort study.

Setting

A medical/surgical ICU at a tertiary care hospital: Hamilton General Hospital, Hamilton, Ontario.

Patients and participants

We recruited 72 mechanically ventilated patients expected to remain in the ICU for more than 48h. Our results were compared to those in healthy volunteers.

Intervention

Within 48 h of admission to the ICU, 1.6 g acetaminophen suspension were administered via a nasogastric tube into the stomach. Blood samples were drawn at=0, 30, 60, 90, and 120 min for measurement of plasma acetaminophen levels determined by the enzymatic degradation method.

Measurements and results

Maximal concentration of acetaminophen was 94.1 (75.3) μmol/l compared to 208.4 (33.1) μmol/l in a control population (p<0.0001). The time to reach the maximal concentration was 105 min (60–180) compared to 30 min (15–90) in controls (p<0.0001). The area under the time-acetaminophen concentration curvet=120 was 9301 (7343) μmol/min per 1 compared to 11644 (1336) μmol/min per 1 in the controls (p=0.28). The variables associated with delayed gastric emptying were age, sex and use of opioids for analgesia and sedation.

Conclusions

Gastric emptying is delayed in critically ill patients. The important consequences of this phenomenon include intolerance to enteral nutrition and gastric colonization. Strategies to minimize the use of narcotics may improve gastric emptying. Studies to examine the effect of gastrointestinal prokinetic agents on gastric emptying are needed.

Key words

Gastrointestinal motilityGastric emptyingCritical careOpioidsProkinetic drugsEnteral nutrition

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • D. K. Heyland
    • 1
  • G. Tougas
    • 2
  • D. King
    • 1
  • D. J. Cook
    • 1
    • 3
  1. 1.Department of Clinical Epidemiology & BiostatisticsMcMaster University, Faculty of Health SciencesHamiltonCanada
  2. 2.Department of Medicine, Division of GastroenterologyMcMaster University, Faculty of Health SciencesHamiltonCanada
  3. 3.Department of Medicine, Division of Critical CareSt. Joseph's HospitalHamiltonCanada
  4. 4.Anagada 3Kingston General HospitalKingstonCanada