CI: Monitoring Criteria: Promotility Agents (2006)

Citation:
Booth CM, Heyland DK, Paterson WG. Gastrointestinal promotility drugs in the critical care setting: A systematic review of the evidence. Crit Care Med 2002; 30:1429-1435. PubMed ID: 12130957
 
Study Design:
Meta-analysis or Systematic Review
Class:
M - Click here for explanation of classification scheme.
Quality Rating:
Positive POSITIVE: See Quality Criteria Checklist below.
Research Purpose:
To systematically review and critically appraise studies of promotility agents in the critical care setting.
Inclusion Criteria:
  • Published research 1980-2001
  • Citation review of relevant articles
  • Contact with primary investigators
Exclusion Criteria:

Not listed

Description of Study Protocol:
  • Medline and EMBASE searches “randomized controlled trial” and “intensive care unit”, “critical care”, “gastrointestinal intubation”, “domperidone”, “erythromycin”,  “metoclopramide”, “octreotide”.
  • Primary studies included were RCT, adult patients in ICU, experimental intervention was promotility agent
  • Maximum of 14 points awarded for concealed randomization, blinding, intent-to-treat analysis, consecutive patient enrollment, comparability of groups at baseline, extend of follow-up, description of treatment protocol, equal use of cointerventions, and assessment of clinically important outcomes.
Data Collection Summary:
  • Relevant methods and outcome data abstracted in duplicate by independent investigators
  • Disagreements resolved by consensus
Description of Actual Data Sample:

43 citations identified from searches

17 additional articles from personal files

Of these 60, 18 met inclusion criteria

Summary of Results:
  • Erythromycin may facilitate post-pyloric tube placement, data on metaclopramide unclear.
  • Promotility agents have a positive effect on GI function, with  faster gastric emptying , and enteral feeding tolerance.
  • No significant difference in volume of gastric residuals vs placebo.
Author Conclusion:
  • Promotility agents have a beneficial effect on gastrointestinal motility in critically ill patients.
  • A one-time dose of erythromycin may facilitate small-bowel feeding tube insertion.
  • Administration of metoclopramide appears to increase physiologic indexes of GI transit and feeding tolerance.
  • Concerns about safety and lack of effect on clinically important outcomes preclude strong treatment recommendations.
  • With cisapride withdrawn from the market and concerns that prolonged erythromycin use may have adverse effects on microbial resistance, metoclopramide is the best available option for increasing GI motility in the critically ill.
Funding Source:
University/Hospital: University of Birmingham
Not-for-profit
0
Foundation associated with industry:
Reviewer Comments:

Clear description of rating methodology.

Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
 
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? Yes
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? Yes
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? Yes
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? Yes
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes