Motility disorders in the ICU: recent therapeutic options and clinical practice
| Autor: | Joachim Boldt, Swen N. Piper, Kerstin D. Röhm |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Adult
medicine.medical_specialty Critical Care Gastrointestinal Diseases Metoclopramide Medicine (miscellaneous) Motility Motilin Enteral Nutrition Gastrointestinal Agents Risk Factors medicine Humans In patient Intensive care medicine Nutrition and Dietetics Gut motility business.industry Critically ill Erythromycin Clinical Practice Intensive Care Units Parenteral nutrition Critical illness Gastrointestinal Motility business |
| Zdroj: | Current Opinion in Clinical Nutrition & Metabolic Care. 12:161-167 |
| ISSN: | 1363-1950 |
| DOI: | 10.1097/mco.0b013e32832182c4 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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