Evidence map›Paper›PMID 27527069›Full record

SynthesisCritical care (London, England)2016

The efficacy and safety of prokinetic agents in critically ill patients receiving enteral nutrition: a systematic review and meta-analysis of randomized trials.

Kim Lewis, Zuhoor Alqahtani, Lauralyn Mcintyre, Saleh Almenawer, Fayez Alshamsi, Andrew Rhodes, Laura Evans, Derek C Angus, Waleed Alhazzani

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Critical care (London, England), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 61 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
61citing papers in PubMed, 10 pooled it
9.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

61 citing papers in PubMed, 10 syntheses or guidelines pooled it, 147 citations in OpenAlex.

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  5. Is metoclopramide beneficial for the postpyloric placement of nasoenteric tubes? A systematic review and meta-analysis of randomized controlled trials.Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition · 2022
    Pooled it
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  7. [S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : Long version].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2020
    Guideline
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1 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 6 institutions in 4 countries.

Kim LewisDepartment of Medicine, McMaster University, 1280 Main St West, Hamilton, Ontario, L8S 4L8, Canada.
Zuhoor AlqahtaniDepartment of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, L8S 4L8, Canada.
Lauralyn McintyreDepartment of Medicine (Critical Care), The Ottawa Hospital Research Institute, University of Ottawa, 1053 Carling Avenue, Rm F202, Ottawa, Ontario, K1H 8L6, Canada.
Saleh AlmenawerDepartment of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, L8S 4L8, Canada.
Fayez AlshamsiDepartment of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, PO Box 15551, Al-Ain, United Arab Emirates.
Andrew RhodesDepartment of Intensive Care Medicine, St George's Hospital, Blackshaw Road, London, SW170QT, UK.
Laura EvansDepartment of Medicine, Division of Pulmonary Medicine and Critical Care, New York University, 550 First Avenue, New York City, NY, 10016, USA.
Derek C AngusDepartment of Critical Care Medicine, University of Pittsburgh School of Medicine, 4200 Fifth Ave, Pittsburgh, Pennsylvania, 15260, USA.
Waleed AlhazzaniDepartment of Medicine, McMaster University, 1280 Main St West, Hamilton, Ontario, L8S 4L8, Canada. alhazzaw@mcmaster.ca.
McMaster University · CANew York University · USOttawa Hospital · CASt George's Hospital · GBUnited Arab Emirates University · AEUniversity of Pittsburgh · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIntolerance to enteral nutrition is common in critically ill adults, and may result in significant morbidity including ileus, abdominal distension, vomiting and potential aspiration events. Prokinetic agents are prescribed to improve gastric emptying. However, the efficacy and safety of these agents in critically ill patients is not well-defined. Therefore, we conducted a systematic review and meta-analysis to determine the efficacy and safety of prokinetic agents in critically ill patients.

methodsWe searched MEDLINE, EMBASE, and Cochrane Library from inception up to January 2016. Eligible studies included randomized controlled trials (RCTs) of critically ill adults assigned to receive a prokinetic agent or placebo, and that reported relevant clinical outcomes. Two independent reviewers screened potentially eligible articles, selected eligible studies, and abstracted pertinent data. We calculated pooled relative risk (RR) for dichotomous outcomes and mean difference for continuous outcomes, with the corresponding 95 % confidence interval (CI). We assessed risk of bias using Cochrane risk of bias tool, and the quality of evidence using grading of recommendations assessment, development, and evaluation (GRADE) methodology.

resultsThirteen RCTs (enrolling 1341 patients) met our inclusion criteria. Prokinetic agents significantly reduced feeding intolerance (RR 0.73, 95 % CI 0.55, 0.97; P = 0.03; moderate certainty), which translated to 17.3 % (95 % CI 5, 26.8 %) absolute reduction in feeding intolerance. Prokinetics also reduced the risk of developing high gastric residual volumes (RR 0.69; 95 % CI 0.52, 0.91; P = 0.009; moderate quality) and increased the success of post-pyloric feeding tube placement (RR 1.60, 95 % CI 1.17, 2.21; P = 0.004; moderate quality). There was no significant improvement in the risk of vomiting, diarrhea, intensive care unit (ICU) length of stay or mortality. Prokinetic agents also did not significantly increase the rate of diarrhea.

conclusionThere is moderate-quality evidence that prokinetic agents reduce feeding intolerance in critically ill patients compared to placebo or no intervention. However, the impact on other clinical outcomes such as pneumonia, mortality, and ICU length of stay is unclear.

Indexed as

Chi-Square DistributionCritical IllnessDiarrheaDomperidoneDopamine AntagonistsEnteral NutritionErythromycinGastric EmptyingHumansIntensive Care UnitsLength of StayMetoclopramideResidual VolumeVomitingDomperidoneDopamine AntagonistsErythromycinMetoclopramideCritical illnessEnteral nutritionGastroparesisProkinetic agentsSystematic review

Identifiers

PMID27527069
PMCPMC4986344
OpenAlexW2514961948

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.