Rong Peng1,2,3,4, Hailong Li1,2,3, Lijun Yang5, Linan Zeng1,2,3, Qiusha Yi1,2,3, Peipei Xu1,2,3, Xiangcheng Pan1,2,3, Lingli Zhang1,2,3. 1. Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China. 2. Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China. 3. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China. 4. Department of Clinical Nutrition, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China. 5. Department of General Practice Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.
Abstract
BACKGROUND: Intolerance to gastric feeding tubes is common among critically ill adults and may increase morbidity. Administration of prokinetics in the ICU is common. However, the efficacy and safety of prokinetics are unclear in critically ill adults with gastric feeding tubes. We conducted a systematic review to determine the efficacy and safety of prokinetics for improving gastric feeding tube tolerance in critically ill adults. METHODS: Randomized controlled trials (RCTs) were identified by systematically searching the Medline, Cochrane and Embase databases. Two independent reviewers extracted the relevant data and assessed the quality of the studies. We calculated pooled relative risks (RRs) for dichotomous outcomes and the mean differences (MDs) for continuous outcomes with the corresponding 95% confidence intervals (CIs). We assessed the risk of bias using the Cochrane risk-of-bias tool and used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to rate the quality of the evidence. RESULTS: Fifteen RCTs met the inclusion criteria. A total of 10 RCTs involving 846 participants were eligible for the quantitative analysis. Most studies (10 of 13, 76.92%) showed that prokinetics had beneficial effects on feeding intolerance in critically ill adults. In critically ill adults receiving gastric feeding, prokinetic agents may reduce the ICU length of stay (MD -2.03, 95% CI -3.96, -0.10; P = 0.04; low certainty) and the hospital length of stay (MD -3.21, 95% CI -5.35, -1.06; P = 0.003; low certainty). However, prokinetics failed to improve the outcomes of reported adverse events and all-cause mortality. CONCLUSION: As a class of drugs, prokinetics may improve tolerance to gastric feeding to some extent in critically ill adults. However, the certainty of the evidence suggesting that prokinetics reduce the ICU or hospital length of stay is low. Prokinetics did not significantly decrease the risks of reported adverse events or all-cause mortality among critically ill adults.
BACKGROUND: Intolerance to gastric feeding tubes is common among critically ill adults and may increase morbidity. Administration of prokinetics in the ICU is common. However, the efficacy and safety of prokinetics are unclear in critically ill adults with gastric feeding tubes. We conducted a systematic review to determine the efficacy and safety of prokinetics for improving gastric feeding tube tolerance in critically ill adults. METHODS: Randomized controlled trials (RCTs) were identified by systematically searching the Medline, Cochrane and Embase databases. Two independent reviewers extracted the relevant data and assessed the quality of the studies. We calculated pooled relative risks (RRs) for dichotomous outcomes and the mean differences (MDs) for continuous outcomes with the corresponding 95% confidence intervals (CIs). We assessed the risk of bias using the Cochrane risk-of-bias tool and used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to rate the quality of the evidence. RESULTS: Fifteen RCTs met the inclusion criteria. A total of 10 RCTs involving 846 participants were eligible for the quantitative analysis. Most studies (10 of 13, 76.92%) showed that prokinetics had beneficial effects on feeding intolerance in critically ill adults. In critically ill adults receiving gastric feeding, prokinetic agents may reduce the ICU length of stay (MD -2.03, 95% CI -3.96, -0.10; P = 0.04; low certainty) and the hospital length of stay (MD -3.21, 95% CI -5.35, -1.06; P = 0.003; low certainty). However, prokinetics failed to improve the outcomes of reported adverse events and all-cause mortality. CONCLUSION: As a class of drugs, prokinetics may improve tolerance to gastric feeding to some extent in critically ill adults. However, the certainty of the evidence suggesting that prokinetics reduce the ICU or hospital length of stay is low. Prokinetics did not significantly decrease the risks of reported adverse events or all-cause mortality among critically ill adults.
Authors: Pierre Singer; Annika Reintam Blaser; Mette M Berger; Waleed Alhazzani; Philip C Calder; Michael P Casaer; Michael Hiesmayr; Konstantin Mayer; Juan Carlos Montejo; Claude Pichard; Jean-Charles Preiser; Arthur R H van Zanten; Simon Oczkowski; Wojciech Szczeklik; Stephan C Bischoff Journal: Clin Nutr Date: 2018-09-29 Impact factor: 7.324
Authors: Charles Chin Han Lew; Rosalie Yandell; Robert J L Fraser; Ai Ping Chua; Mary Foong Fong Chong; Michelle Miller Journal: JPEN J Parenter Enteral Nutr Date: 2016-02-02 Impact factor: 4.016
Authors: Daren K Heyland; Arthur R H van Zanten; Teodoro Grau-Carmona; David Evans; Albertus Beishuizen; Jeroen Schouten; Oscar Hoiting; Maria Luisa Bordejé; Kenneth Krell; David J Klein; Jesus Gonzalez; Aitor Perez; Randy Brown; Joyce James; M Scott Harris Journal: Intensive Care Med Date: 2019-05-06 Impact factor: 41.787