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Gastric emptying in mechanically ventilated critically ill patients: effect of neuromuscular blocking agent

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Abstract

Objective

To assess gastrointestinal function in critically ill patients receiving muscle relaxant and to test clinical tolerance to enteral nutrition.

Design and setting

Prospective study in an intensive care unit.

Patients

20 critically ill patients requiring sedation with muscle relaxant to obtain adequate mechanical ventilation.

Measurements and results

Patients were randomly selected to receive infusions of opioid sedation during the first session (session 1) and the same sedation with muscle relaxation (cisatracurium) during the second session (session 2). Gastric emptying was assessed by the paracetamol absorption technique. Following the paracetamol absorption 200 ml enteral feed was given, and the residual gastric volume was measured 1 and 2 h after feeding. The maximum plasma concentration (Cmax) was 14 mg/l (range 5–26) when patients received sedation, and 12 mg/l (range 5–30) when they received muscle relaxant. The target time for reaching the maximum plasma concentration (Tmax) was 30 min (range 20–60) and 35 min (range 20–60), respectively, in sessions 1 and 2. There was no significant difference between the two session as regards Tmax, Cmax, or AUC0–120. The residual volumes were 110±65 ml (H1) and 95±76 ml (H2) during session 1 and 125±85 ml (H1) and 105±90 ml (H2) during session 2.

Conclusions

Enteral feeding is one of the most effective methods of supporting nutritional needs in the critically ill patient. We conclude that in critically ill patients requiring sedation gastric emptying is not improved by neuromuscular blocking agent.

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Acknowledgements

The authors thank Richard Medeiros, Rouen University Hospital Medical Editor, for his valuable advice in editing the manuscript.

Author information

Authors and Affiliations

  1. Medical Intensive Care Unit, Hospital Charles Nicolle, Rouen University, 1 rue de Germont, 76031, Rouen, France

    Fabienne Tamion, Karine Hamelin, Christophe Girault, Jean-Christophe Richard & Guy Bonmarchand

  2. Department of Biochemistry, Hospital Charles Nicolle, Rouen University, 1 rue de Germont, 76031, Rouen, France

    Annie Duflo

Authors
  1. Fabienne Tamion
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  2. Karine Hamelin
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  3. Annie Duflo
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  4. Christophe Girault
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  5. Jean-Christophe Richard
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  6. Guy Bonmarchand
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Corresponding author

Correspondence to Fabienne Tamion.

Additional information

This study was supported by a grant from Charles Nicolle Hospital (98097 HP)

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Tamion, F., Hamelin, K., Duflo, A. et al. Gastric emptying in mechanically ventilated critically ill patients: effect of neuromuscular blocking agent. Intensive Care Med 29, 1717–1722 (2003). https://doi.org/10.1007/s00134-003-1898-5

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  • DOI: https://doi.org/10.1007/s00134-003-1898-5

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