Mechanisms underlying feed intolerance in the critically ill: Implications for treatment

Figure 1 Manometric tracing from healthy and critically ill subjects during duodenal feeding (1 kcal/min). Location of pressure sensors is shown on left. In the healthy subjects antral and duodenal peristalsis is seen, whilst the increase in activity in the pylorus in the critically ill is associated with absent antral activity[36].

Figure 2 Kaplan Meier plots comparing the effects of erythromycin (200 mg IV BD) and metoclopramide (10 mg IV QID) in the treatment of feed intolerance. Significant tolerance developed to both drugs over 7 d. The combination of both drugs is effective rescue therapy[81].

Figure 3 Plasma CCK concentrations during fasting and duodenal nutrient stimulation in both feed tolerant and intolerant critically ill patients. Plasma levels of CCK for feed tolerant patients match those seen in healthy subjects receiving intra duodenal nutrition. Feed intolerant patients have higher levels whilst fasting and during enteral nutrition compared to feed tolerant (^aP < 0.01)[41].