When and how to manage enteral feeding intolerance?

Excerpt

In this issue of Intensive Care Medicine, Heyland et al. reported the results of the PROMOTE Trial [1]. In this international multicenter (20 sites, 4 countries) randomized double-blind study, 120 critically ill patients who had enteral feeding intolerance (EFI) were randomized to receive ulimorelin or metoclopramide for 5 days. A volume-based feeding protocol was employed, with a starting feeding rate of 40 mL/h and maximum rate of 150 mL/h. Gastric residual volumes (GRV) were measured every 6 h, and the feeding rate was increased if GRV was < 500 mL, and reduced if GRV was ≥ 500 mL; if GRV ≥ 500 mL persisted in two consecutive measurements with feeding 10 mL/h beyond day 1, the study drug was discontinued. …