Gastric emptying measurement of liquid nutrients using the (13)C-octanoate breath test in critically ill patients: a comparison with scintigraphy.

Purpose: Scintigraphy is considered the most accurate technique for the measurement of gastric emptying (GE) but, for patients in the intensive care unit, it is technically demanding, involves radiation and can interfere with care. The (13)C-octanoate breath test ((13)C-OBT) is a simple, non-invasive technique that does not involve radiation exposure.

Aim: To evaluate the performance of the (13)C-OBT in the assessment of GE in critically ill patients.

Plasma erythromycin concentrations predict feeding outcomes in critically ill patients with feed intolerance.

Objective: Motilin receptors are rapidly down-regulated by exposure to erythromycin, and its progressive loss of clinical prokinetic effect may relate to higher plasma drug concentrations. This study aimed to evaluate the relationship between plasma erythromycin concentrations and feeding outcomes in critically ill patients.

Design: Observational comparative study.

Impact of bolus volume on small intestinal intra-luminal impedance in healthy subjects.

Aim: To assess the impact of bolus volume on the characteristics of small intestinal (SI) impedance signals.

Methods: Concurrent SI manometry-impedance measurements were performed on 12 healthy volunteers to assess the pattern of proximal jejunal fluid bolus movement over a 14 cm-segment. Each subject was given 34 boluses of normal saline (volume from 1 to 30 mL) via the feeding tube placed immediately above the proximal margin of the studied segment.

The impact of delaying enteral feeding on gastric emptying, plasma cholecystokinin, and peptide YY concentrations in critically ill patients.

Background: Enteral nutrient (EN) deprivation slows gastric emptying (GE) and increases plasma cholecystokinin (CCK) concentrations in healthy humans and may potentially contribute to the delayed GE in the critically ill. This study examined the impact of delayed feeding on GE, plasma CCK, and peptide YY (PYY) concentrations in the critically ill.

Design: Randomized controlled trial.

Diminished functional association between proximal and distal gastric motility in critically ill patients.

Objective: This study examined the effects of critical illness on the relationship between proximal and distal gastric motor activity during fasting and duodenal nutrient stimulation.

Design: Prospective, case-controlled study.

Patients And Participants: Ten critically ill patients and ten healthy volunteers.

The relationship between gastric emptying, plasma cholecystokinin, and peptide YY in critically ill patients.

Background: Cholecystokinin (CCK) and peptide YY (PYY) are released in response to intestinal nutrients and play an important physiological role in regulation of gastric emptying (GE). Plasma CCK and PYY concentrations are elevated in critically ill patients, particularly in those with a history of feed intolerance. This study aimed to evaluate the relationship between CCK and PYY concentrations and GE in critical illness.

The effects of sedation on gastric emptying and intra-gastric meal distribution in critical illness.

Objective: To evaluate the effects of sedation with morphine and midazolam (M&M) versus propofol on gastric emptying in critically ill patients.

Design: Descriptive study.

Setting: Mixed medical and surgical intensive care unit.

Prokinetic therapy for feed intolerance in critical illness: one drug or two?

Objective: To compare the efficacy of combination therapy, with erythromycin and metoclopramide, to erythromycin alone in the treatment of feed intolerance in critically ill patients.

Design: Randomized, controlled, double-blind trial.

Setting: Mixed medical and surgical intensive care unit.

Mechanisms underlying feed intolerance in the critically ill: implications for treatment.

Malnutrition is associated with poor outcomes in critically ill patients. Although nutritional support is yet to be proven to improve mortality in non-malnourished critically ill patients, early enteral feeding is considered best practice. However, enteral feeding is often limited by delayed gastric emptying.

Proximal gastric motility in critically ill patients with type 2 diabetes mellitus.

Aim: To investigate the proximal gastric motor response to duodenal nutrients in critically ill patients with long-standing type 2 diabetes mellitus.

Methods: Proximal gastric motility was assessed (using a barostat) in 10 critically ill patients with type 2 diabetes mellitus (59 +/- 3 years) during two 60-min duodenal infusions of Ensure (1 and 2 kcal/min), in random order, separated by 2 h fasting. Data were compared with 15 non-diabetic critically ill patients (48 +/- 5 years) and 10 healthy volunteers (28 +/- 3 years).

Erythromycin is more effective than metoclopramide in the treatment of feed intolerance in critical illness.

Objective: This study aimed to a) compare the efficacy of metoclopramide and erythromycin in the treatment of feed intolerance in critical illness; and b) determine the effectiveness of "rescue" combination therapy in patients who fail monotherapy.

Design: Randomized controlled trial.

Setting: Level III mixed medical and surgical intensive care unit.

Fasting and nutrient-stimulated plasma peptide-YY levels are elevated in critical illness and associated with feed intolerance: an observational, controlled study.

Introduction: Delayed gastric emptying and feed intolerance occur frequently in the critically ill. In these patients, gastric motor responses to nutrients are disturbed. Peptide YY (PYY) slows gastric emptying.

Feed intolerance in critical illness is associated with increased basal and nutrient-stimulated plasma cholecystokinin concentrations.

Objective: Delayed gastric emptying and intolerance to gastric feeding occur frequently in the critically ill. In these patients, gastric motor responses to nutrients are disturbed. Cholecystokinin (CCK) slows gastric emptying.

Proximal gastric response to small intestinal nutrients is abnormal in mechanically ventilated critically ill patients.

Aim: To determine the response of the proximal stomach to small intestinal nutrients in critically ill patients.

Methods: Proximal gastric motility was measured in 13 critically ill patients (49.3 +/- 4.

Long-standing type II diabetes mellitus is not a risk factor for slow gastric emptying in critically ill patients.

Objective: Delayed gastric emptying (GE) is common both in critical illness and in patients with diabetes mellitus (DM). The effect of DM on the incidence of slow GE in these patients is unknown. We evaluated the effect of DM on liquid GE in critically ill patients.