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Any news from the prokinetic front?

Deane, Adam M.a,b; Chapman, Marianne J.c,d; Abdelhamid, Yasmine Alia,b

Current Opinion in Critical Care: August 2019 - Volume 25 - Issue 4 - p 349–355
doi: 10.1097/MCC.0000000000000634
METABOLIC SUPPORT: Edited by Mette M. Berger
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Purpose of review This review provides an update of recently conducted studies and randomized controlled trials evaluating prokinetic drugs.

Recent findings Prokinetic drugs accelerate gastric emptying and, particularly in patients with gastric dysmotility and enteral feed intolerance, their use increases the delivery of enteral nutrition. However, prokinetic drugs have not been shown to improve patient-centered outcomes in trials but benefit is assumed on the basis of observational studies, which report close associations between gastric dysmotility, enteral feed intolerance and poor outcomes, and improvement in surrogate physiological outcomes when prokinetic drugs are administered.

Summary It may not be feasible to establish superiority of a prokinetic drug within a randomized controlled trial with a patient-centered event as the primary outcome. The use of metoclopramide and erythromycin as prokinetic drugs is based on observations from trials measuring surrogate physiological outcomes. Randomized controlled trials of alternative drug regimens and novel prokinetic drugs have recently been completed and results outlined.

aIntensive Care Unit, Royal Melbourne Hospital

bDepartment of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria

cIntensive Care Unit, Royal Adelaide Hospital

dDiscipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia

Correspondence to Adam M. Deane, MBBS, FCICM, FRACP, PhD, Intensive Care Unit, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia. Tel: +61 3 9342 9253; e-mail: adam.deane@mh.org.au

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