Erythromycin improves gastric emptying in critically ill patients intolerant of nasogastric feeding

Objective: To evaluate the effect of intravenous erythromycin on gastric emptying and the success of enteral feeding in mechanically ventilated, critically ill patients with large volume gastric aspirates. Design: Prospective, double-blind, randomized, and placebo-controlled trial. Setting: General intensive care unit in a university hospital. Patients: Twenty critically ill, mechanically ventilated patients intolerant of nasogastric feeding (indicated by a residual gastric volume of greater than or equal to 250 mt during feed administration at greater than or equal to 40 mL/hr), Interventions: After a gastric aspirate of greater than or equal to 250 mt, which was discarded, the enteral feeding was continued at the previous rate for 3 hrs, Intravenous erythromycin (200 mg) or placebo was then administered over 20 mins, The residual gastric contents were again aspirated and the volume was recorded 1 hr after the infusion began. Measurements and Main Results: Gastric emptying was calculated as volume of feed infused into the stomach over 4 hrs minus the residual volume aspirated. Mean gastric emptying was 139 +/- 37 (+/-SEM) mt after erythromycin and -2 +/- 46 mt after placebo (p = .027), Nasogastric feeding was successful in nine of ten patients treated with erythromycin and five of ten who received placebo 1 hr after infusion (chi-square p = .05), Conclusion: In critically ill patients who have large volumes of gastric aspirates indicating a failure to tolerate nasogastric feeding, a single small dose of intravenous erythromycin allows continuation of feed in the short term.