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SHR Neuro Cancer Cardio Lipid Metab Microb

Herbert, MK; Holzer, P.
Treatment of impaired gastrointestinal motility in the critically ill patient
ANASTHESIOL INTENSIVMEDIZIN. 2009; 50: 602-615.
Web of Science

Leading authors Med Uni Graz: Herbert Michael K.
Co-authors Med Uni Graz: Holzer Peter
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Abstract:: Inhibition of gastrointestinal motility is a serious complication in critically ill patients. Approximately one-half of all mechanically ventilated patients exhibit antral hypomotility, decreased gastric emptying and diminished migrating motor complexes. Impaired gastrointestinal motility leads to a number of subsequent complications in critically ill patients, with intolerance of enteral feeding as one of great importance. The pharmacological treatment of impaired gastrointestinal motility presents the clinician with a difficult problem, since the underlying mechanisms are complex and often not fully understood, and the pharmacological options available are limited. A standardized concept for the use of prokinetic agents in the treatment of impaired gastrointestinal motility in critically ill patients involves the early use of basic therapeutic options followed by specific goal-directed therapy. The early use of enemas and laxatives to promote water secretion and prevent excessive water absorption, such as bisacodyl or sodium picosulfate, is recommended. Alternative options are the use of magnesium salts or polyethylene glycol. First-line medication in patients with impaired gastric emptying is erythromycin given intravenously. Patients suffering from gastroparesis and impaired intestinal motility may benefit from erythromycin followed, several hours later, by a combination of metoclopramide and neostigmine. As a supportive measure, enteral administration of opioid receptor antagonists, such as naloxone or methylnaltrexone, to antagonize selectively and locally the inhibitory effect of opioids on gastrointestinal motility may be considered.
Find related publications in this database (Keywords): Inhibition of Gastrointestinal Motility; Critically Ill Patients; Prokinetic Drugs; Mechanism of Action