Skip to main content
SpringerLink
Log in

Impaired gastric emptying in mechanically ventilated, critically ill patients

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hart CA (1989) Defence against colonization and infection. In: Van Saene HKF, Stoutenbeek CP, Ledingham IMcA (eds) Update in intensive care and emergency medicine-Infection control by selective decontamination. Springer, Germany pp 13–21

    Google Scholar 

  2. King CE, Toskes PP (1979) Small intestine overgrowth. Gastroenterology 76: 1035–1055

    Google Scholar 

  3. Heyland DK, Mandell LA (1992) Gastric colonization and nosocomial pneumonia: evidence for causation. Chest 101: 187–193

    PubMed  Google Scholar 

  4. Fink MP (1991) Gastrointestinal mucosal injury in experimental models of shock, trauma and sepsis. Crit Care Med 19: 627–641

    PubMed  Google Scholar 

  5. Heyland D, Winder B, Cook DJ, Brylowski L, Guyatt G (1995) Enteral nutrition in the critically ill patient: a prospective survey. Crit Care Med 23: 1055–1060

    PubMed  Google Scholar 

  6. Heyland DK, Cook DJ, Winder B, Guyatt GH (1996) How well do critically ill patients tolerate early, intragastric enteral nutrition. Clin Intensive Care 7: 68–73

    Google Scholar 

  7. Harasawa A, Tani N, Suzuki S, Miwa M, Sakita R, Nomiyama T, Miva T (1979) Gastric emptying in normal subjects and in patients with peptic ulcer. A study using the acetaminophen method. Gastroenterol Jpn 14: 1–5

    Google Scholar 

  8. Imbimbo BP, Gardino L, Palmas F, Frascio M, Canepa G, Scarpignato C (1990) Different effects of atropine and cimetropium bromide on gastric emptying of liquids and antroduodenal motor activity in man. Hepatogastroenterology 37: 242–246

    PubMed  Google Scholar 

  9. Power I, Easton JC, Todd JG, Nimmo WS (1989) Gastric emptying after head injury. Anaesthesia 44: 563–566

    PubMed  Google Scholar 

  10. Hu OY, Ho ST, Wang JJ et al. (1993) Evaluation of gastric emptying in severe, burn-injured patients. Crit Care Med 21: 527–531

    PubMed  Google Scholar 

  11. Dive A, Galanti L, Jamart J, Evrard P, Gonzalez M, Installe E (1995) Effect of erythromycin on gastric motility in mechanically ventilated critically ill patients: a double-blind, randomized, placebo-controlled study. Crit Care Med 23: 1356–1362

    PubMed  Google Scholar 

  12. McArthur CJ, Gin T, McLaren IM, Critchley JAJH, Oh TE (1995) Gastric emptying following brain injury: effects of choice of sedation and intracranial pressure. Intensive Care Med 21: 573–576

    PubMed  Google Scholar 

  13. Clements JA, Heading RC, Nimmo WS, Prescott LF (1978) Kinetics of acetaminophen absorption and gastric emptying in man. Clin Pharmacol Ther 24: 420–431

    PubMed  Google Scholar 

  14. Heading RC, Nimmo J, Prescott LF, Tothill P (1973) The dependence of paracetamol absorption on the rate of gastric emptying. Br J Clin Pharmacol 47: 415–421

    Google Scholar 

  15. Petring OU, Flachs H (1990) Inter- and intra-subject variability of gastric emptying in healthy volunteers measured by scintigraphy and paracetamol absorption. Br J Clin Pharmacol 29: 703–708

    PubMed  Google Scholar 

  16. Rowbotham DJ, Parnacott S, Nimmo WS (1992) No effect of cisapride on paracetamol absorption after oral simultaneous administration. Eur J Clin Pharm 42: 235–236

    Google Scholar 

  17. Chatfield C (1988) Problem solving: a statistician's guide. Chapman and Hall, London

    Google Scholar 

  18. Draper NR, Smith H (1981) Applied regression analysis. Wiley, New York, pp 305–307

    Google Scholar 

  19. Nimmo WS, Heading RC, Wilson J, Tothill P, Prescott LF (1975) Inhibition of gastric emptying and drug absorption by narcotic analgetics. Br J Clin Pharmacol 2: 509–513

    PubMed  Google Scholar 

  20. Dive A, Moulart M, Jonard P, Jamart J, Mahieu P (1994) Gastroduodenal motility in mechanically ventilated critically ill patients: a manometric study. Crit Care Med 22: 441–447

    PubMed  Google Scholar 

  21. Heyland DK, Cook DJ, Guyatt GH (1993) Enteral nutrition: A critical appraisal of the evidence. Intensive Care Med 19: 435–442

    PubMed  Google Scholar 

  22. Ott L, Young B, Phillips R, McClain C, Adams L, Dempsey R, Tibbs P, Ryo UY (1991) Altered gastric emptying in the head-injured patient: relationship to feeding intolerance. J Neurosurg 74: 738–742

    PubMed  Google Scholar 

  23. Atherton ST, White DJ (1978) Stomach as source of bacterial colonising respiratory tract during artificial respiration. Lancet 2: 968–969

    PubMed  Google Scholar 

  24. Tryba M (1991) The gastropulmonary route of infection: fact or fiction. Am J Med 91 (Suppl 2A): 135S-146S

    PubMed  Google Scholar 

  25. Daschner F, Kappstein I, Engels I, Reuschenbach K, Pfisterer J, Kreig N, et al. (1988) Stress ulcer prophylaxis and ventilation pneumonia: prevention by antibacterial cytoprotective agents. Infect Control Hosp Epidemiol 9: 59–65

    PubMed  Google Scholar 

  26. Du Moulin GC, Hedley-Whyte J, Paterson DJ, Lisbon A (1982) Aspiration of gastric bacteria in antacid-treated patients: a frequent cause of postoperative colonization of the airway. Lancet 1: 242–245

    PubMed  Google Scholar 

  27. Goularte TA, Lichtenberg DA, Craven DE (1986) Gastric colonization in patients receiving antacids and mechanical ventilation: a mechanism for pharyngeal colonization. Am J Infect Control 14: 88

    Google Scholar 

  28. Schwartz SN, Dowling JN, Denkovic C, DeQuittner-Buchanan M, Prostko T, Yee R (1978) Sources of gram-negative bacilli colonizing the trachea of intubated patients. J Infect Dis 138: 227–231

    PubMed  Google Scholar 

  29. Inglis TJJ, Sproat LJ, Sherratt MJ, Hawkey PM, Gibson JS, Shah MV (1992) Gastroduodenal dyfunction as a cause of gastric bacterial overgrowth in patients undergoing mechanical ventilation of the lungs. Br J Anaesth 68: 499–502

    PubMed  Google Scholar 

  30. Inglis TAJ, Sherratt MJ, Sproat LJ, Gibson JS, Hawkey PM (1993) Gastroduodenal dysfunction and bacterial colonization of the ventilated lung. Lancet 341: 911–913

    PubMed  Google Scholar 

  31. Ibanez J, Penafiel A, Rauriach JM, Marse P, Jorda R, Mata F (1992) Gastroesophageal reflux in intubated patients receiving enteral nutrition: effect of supine and semirecumbent positions. JPEN 16: 419–422

    Google Scholar 

  32. Torres A, Serr-Batlles J, Ros E, Piera C, Puig de la Bellacasa J, Cobos A, Lomena F, Rodriguez-Roisin R (1992) Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann Intern Med 116: 540–543.

    PubMed  Google Scholar 

  33. Orozco-Levi M, Torres A, Ferrer M, Peira C, El-Ebiary M, Puig de la Bellacasa J, Rodrigeuez-Roisin R (1995) Semirecumbent position protects from pulmonary aspiration but not completely from gastroesophageal reflux in mechanically ventilated patients. Am J Respir Crit Care Med 152: 1387–1390

    PubMed  Google Scholar 

  34. Bion JF, Ledingham ImcA (1987) Sedation in intensive care- a postal survey. Intensive Care Med 13: 215–216

    PubMed  Google Scholar 

  35. Dasta JF, Fuhrman TM, McCandles C (1994) Patterns of prescribing and administering drugs for agitation and pain in patients in a surgical intensive care unit. Crit Care Med 22: 974–980

    PubMed  Google Scholar 

  36. Spapen H, Duinslaeger L, Diltoer M, Gillet R, Bossuyt A, Huyghens (1995) Gastric emptying in critically ill intensive-care patients is accelerated by adding cisapride to a standard enteral feeding protocol. Crit Care Med 23: 481–485

    PubMed  Google Scholar 

  37. Heyland DK, Tougas G, Cook DJ, Guyatt GH (1996) The effect of cisapride on gastric emptying in critically ill patients (Abstract) Am J Respir Crit Care Med 153: A832

    Google Scholar 

Download references

Author information

Author notes

  1. D. K. Heyland

    Present address: Anagada 3, Kingston General Hospital, 76 Stuart Street, K7L 2V7, Kingston, Ontario, Canada

Authors and Affiliations

  1. Department of Clinical Epidemiology & Biostatistics, McMaster University, Faculty of Health Sciences, K7L 3N, Hamilton, Ontario, Canada

    D. K. Heyland, D. King & D. J. Cook

  2. Department of Medicine, Division of Gastroenterology, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada

    G. Tougas

  3. Department of Medicine, Division of Critical Care, St. Joseph's Hospital, Hamilton, Ontario, Canada

    D. J. Cook

Authors
  1. D. K. Heyland
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Tougas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. King
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. J. Cook
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heyland, D.K., Tougas, G., King, D. et al. Impaired gastric emptying in mechanically ventilated, critically ill patients. Intensive Care Med 22, 1339–1344 (1996). https://doi.org/10.1007/BF01709548

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01709548

Key words

Search

Navigation