Nutrition and the intensive care unit: Edited by Mette Berger and Jeffrey I MechanickMotility disorders in the ICU: recent therapeutic options and clinical practiceRöhm, Kerstin Da; Boldt, Joachima; Piper, Swen Nb Author Information aDepartment of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Ludwigshafen, Germany bDepartment of Anaesthesiology and Intensive Care Medicine, Hospital of Frankenthal, Frankenthal, Germany Correspondence to Dr Kerstin Denise Röhm, Klinikum Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Bremserstrasse 79, D-67063 Ludwigshafen, Germany Tel: +49 621 503 3000; fax: +49 621 503 3024; e-mail: [email protected] Current Opinion in Clinical Nutrition and Metabolic Care: March 2009 - Volume 12 - Issue 2 - p 161-167 doi: 10.1097/MCO.0b013e32832182c4 Buy Metrics Abstract Purpose of review Motility disturbances often occur in critically ill patients resulting in an increased rate of morbidity and mortality. Only limited options for treatment of gastrointestinal dysfunction have been introduced. Factors contributing to motility disorders in the ICU patient, and recent therapeutic approaches are reviewed in the following. Recent findings Despite the growing use of early enteral nutrition in the ICU and improvements in patients' outcome, feed intolerance and motility disorders in critical illness remain unsolved. Evaluation of pathophysiological patterns such as antro-pyloric dysfunction has led to a better knowledge of gut function, whereas development of new prokinetic agents is scarce, and enthusiasm has been cut by the withdrawal of some propulsive agents from the market. Summary The complexity of gastrointestinal motor function poses a challenge to the pharmacological modulation of gut motility. There has been progress in the understanding of pathophysiologic patterns, whereas therapeutic options are still rare. Metoclopramide and erythromycin are the best evaluated and still the most promising prokinetic agents. Only a few studies in critical illness are available, and the definite value of novel propulsive agents such as motilin agonists and μ-receptor antagonists is unclear due to small patient populations. The most reasonable approach of motility disorders in critical illness seems to be an individual assessment of all associated risk factors combined with early enteral nutrition and use of prokinetic agents. © 2009 Lippincott Williams & Wilkins, Inc.