Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul;69(6):e70045.
doi: 10.1111/aas.70045.

Preferences on the Use of Prokinetic Agents in Adult Intensive Care Unit Patients-An International Survey

Vera Crone  1 , Morten Hylander Møller  2   3 , Waleed Alhazzani  4   5 , Lasse Grønningsæter  6 , Abdulrahman Al-Fares  7 , Johanna Hästbacka  8 , Marlies Ostermann  9 , Carmen A Pfortmueller  10 , Ricard Ferrer  11 , Annika Reintam Blaser  12   13 , Martin I Sigurdsson  14   15 , Olof Wall  16 , Eric Keus  17 , Wojciech Szczeklik  18 , Paul J Young  19   20 , Chris McGrath  21 , Maurizio Cecconi  22   23 , Anders Perner  2   3 , Mette Krag  3   24
Affiliations

Preferences on the Use of Prokinetic Agents in Adult Intensive Care Unit Patients-An International Survey

Vera Crone et al. Acta Anaesthesiol Scand. 2025 Jul.

Abstract

Introduction: Feeding intolerance complicates enteral nutrition in intensive care unit (ICU) patients but is poorly defined. Prokinetic agents are administered to facilitate the uptake of enteral nutrition, but preferences for their use among clinicians in ICUs are unknown.

Methods: We conducted an international electronic survey targeting ICU doctors. The survey included 76 questions that focused on symptoms considered when assessing feeding intolerance, preferences for using prokinetic agents, and willingness to participate in a future randomised trial on prokinetic agents.

Results: We received 830 responses from 17 countries, with an overall response rate of 29%. Most respondents were specialists working in mixed ICUs. Feeding intolerance was assessed by 90% of respondents in their clinical work, though only 36% considered it well defined. Gastric residual volume and vomiting were symptoms most frequently used for defining feeding intolerance. Metoclopramide was the preferred prokinetic agent (54% of respondents), followed by erythromycin (42%). Four out of five considered using combination therapy, primarily a combination of metoclopramide and erythromycin (89%). Concerns about side effects were reported for all agents, with extrapyramidal symptoms and QT prolongation being the most common across agents. The majority (91%) of respondents supported a future randomised trial comparing prokinetic agents to placebo.

Conclusion: This international survey found practice variations in the symptoms reportedly used to assess feeding intolerance. Metoclopramide was the preferred prokinetic agent, followed by erythromycin. Most respondents supported a future randomised trial.

Keywords: feeding intolerance; intensive care; prokinetic agents; survey.

PubMed Disclaimer

Conflict of interest statement

The Department of Intensive Care at Rigshospitalet‐Copenhagen University Hospital (MHM) has received funding from the Novo Nordisk Foundation and Sygeforsikringen ‘Denmark’ outside the submitted work. A.R.B. has received speaker or consultancy fees from Nutricia and VIPUN Medical and is holding a grant from the Estonian Research Council (PRG1255) outside the submitted work. The Department of Intensive Care, University Hospital, Inselspital, reports grants from Orion Pharma, Abbott Nutrition International, B. Braun Medical AG, CSEM AG, Edwards Lifesciences Services GmbH, Kenta Biotech Ltd., Maquet Critical Care AB, Omnicare Clinical Research AG, Nestle, Pierre Fabre Pharma AG, Pfizer, Bard Medica S.A., Abbott AG, Anandic Medical Systems, Pan Gas AG Healthcare, Bracco, Hamilton Medical AG, Fresenius Kabi, Getinge Group Maquet AG, Dräger AG, Teleflex Medical GmbH, GlaxoSmithKline, Merck Sharp and Dohme AG, Eli Lilly and Company, Baxter, Astellas, AstraZeneca, CSL Behring, Novartis, Covidien, Phagenesis, Cytel and Nycomed outside the project. The money was paid into departmental funds; no personal financial gain applied. Finally, this research was conducted during the tenure of a Health Research Council of New Zealand Clinical Practioner Research Fellowship held by Paul Young. The Medical Research Institute of New Zealand is supported by Independent Research Organisation Funding from the Health Research Council of New Zealand.

Figures

FIGURE 1
FIGURE 1
Gastrointestinal symptoms considered when assessing feeding intolerance. It was possible to select more than one symptom. Some chose to respond only to certain symptoms, leaving other symptoms unaddressed (numbers and percentages in Supporting Information). Missingness was less than 2%.
FIGURE 2
FIGURE 2
The reported doses and frequencies of metoclopramide selected as the preferred first or second choice. Total number of respondents = 726.
FIGURE 3
FIGURE 3
The reported doses and frequencies of erythromycin selected as preferred first or second choice. Total number of respondents = 692.
FIGURE 4
FIGURE 4
(A) Reported concerns about side effects when prescribing metoclopramide. Total number of respondents = 582. It was possible to select more than one side effect. * The main concerns under the category of ‘other’ were cerebral symptoms, abdominal pain and delirium. (B) Reported concerns about side effects when prescribing erythromycin. Total number of respondents = 460. It was possible to select more than one side effect. *The main concerns mentioned under the ‘other’ category were drug interactions, antibiotic resistance, abdominal pain and allergy.
See this image and copyright information in PMC

References

    1. Li J., Wang L., Zhang H., et al., “Different Definitions of Feeding Intolerance and Their Associations With Outcomes of Critically Ill Adults Receiving Enteral Nutrition: A Systematic Review and Meta‐Analysis,” Journal of Intensive Care 11 (2023): 29. - PMC - PubMed
    1. Reintam Blaser A., Deane A. M., Preiser J. C., Arabi Y. M., and Jakob S. M., “Enteral Feeding Intolerance: Updates in Definitions and Pathophysiology,” Nutrition in Clinical Practice 36, no. 1 (2021): 40–49, 10.1002/ncp.10599. - DOI - PubMed
    1. Blaser A. R., Starkopf J., Kirsimägi Ü., and Deane A. M., “Definition, Prevalence, and Outcome of Feeding Intolerance in Intensive Care: A Systematic Review and Meta‐Analysis,” Acta Anaesthesiologica Scandinavica 58 (2014): 914–922. - PubMed
    1. Karamanolis G. and Tack J., “Promotility Medications ‐ Now and in the Future,” Digestive Diseases 24 (2006): 297–307. - PubMed
    1. Crone V., Møller M. H., Bækgaard E. S., et al., “Use of Prokinetic Agents in Hospitalised Adult Patients: A Scoping Review,” Acta Anaesthesiologica Scandinavica 67 (2023): 588–598, 10.1111/aas.14222. - DOI - PubMed