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Intensive Care Medicine
Published in: Intensive Care Medicine 3/2008

01-03-2008 | Original

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

Authors: Nam Q. Nguyen, Marianne J. Chapman, Robert J. Fraser, Laura K. Bryant, Carly Burgstad, Katrina Ching, Max Bellon, Richard H. Holloway

Published in: Intensive Care Medicine | Issue 3/2008

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Abstract

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.

Patients

Thirty-six unselected, mechanically ventilated, critically ill patients.

Interventions

Gastric scintigraphic data were analysed retrospectively according to whether patients were receiving M&M (n = 20; 14M, 6F) or propofol (n = 16; 7M, 9F). Measurements were performed over 4 h after administration of 100 ml of Ensure®, labelled with 20 MBq Tc99m.

Measurements and results

Gastric half-emptying time (t1/2) and total and regional (proximal and distal stomach) meal retention (%) were assessed. The median t1/2 of patients receiving M&M (153 (IQR: 72–434) min) was significantly longer than that of patients receiving propofol (58 (34–166) min, p = 0.02). Total gastric retention was greater in patients receiving M&M compared to those receiving propofol (p < 0.01). Proximal (p = 0.02) but not distal (p = 0.80) gastric retention was greater in patients who received M&M. Patients who received M&M were more likely to have ≥ 5% meal retention at 240 min than thosetreated with propofol (95% (19/20) vs. 56% (9/16); p = 0.01). Changes in blood glucose concentrations during the study were similar in the two groups.

Conclusions

In critical illness, patients receiving M&M for sedation are more likely to have slow gastric emptying, and proximal meal retention than those receiving propofol. The apparent beneficial effects of propofol-based sedation need confirmation by a prospective randomised controlled study.
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Metadata
Title
The effects of sedation on gastric emptying and intra-gastric meal distribution in critical illness
Authors
Nam Q. Nguyen
Marianne J. Chapman
Robert J. Fraser
Laura K. Bryant
Carly Burgstad
Katrina Ching
Max Bellon
Richard H. Holloway
Publication date
01-03-2008
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 3/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-007-0942-2

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