Cisapride decreases gastric content aspiration in mechanically ventilated patients

Objective:
To determine the effect of the prokinetic agent cisapride in the
prevention of aspiration of gastric contents.

      Design:
      A prospective randomized two-period crossover study.


      Setting:
      Fourteen-bed polyvalent intensive care unit in a University
            Hospital.


      Patients:
      Eighteen intubated, mechanically ventilated patients who were
            seated in a semirecumbent position were studied.


      Method:
      Tc-99 m sulfur colloid (80 megabecquerels) was administered via
            nasogastric tube on 2 consecutive days. Patients randomly received cisapride
            (10 mg, via nasogastric tube) one day and a placebo the other. Bronchial
            secretions were obtained before and for 5 consecutive h after Tc-99 m
            administration. The radioactivity was measured in a standard amount (1ml) of
            bronchial fluid using a gamma counter and expressed as counts per min (cpm)
            after correction for decay.


      Results:
      Sixteen out of 18 (88%) patients had increased radioactivity in
            bronchial secretions. The radioactivity increased over time both with and
            without cisapride, although it was lower in patients receiving cisapride than
            in those receiving a placebo. The cumulative bronchial secretion radioactivity
            obtained when patients received cisapride was significantly lower than when
            patients received a placebo: 7540 ± 5330 and 21965 ± 16080 cpm,
            respectively (P <0.05).


      Conclusion:
      Our results suggest that aspiration of gastric contents exists
            even in patients who are kept in a semirecumbent position. Moreover, cisapride
            decreases the amount of gastric contents aspiration in intubated and
            mechanically ventilated patients and may play a role in the prevention of
            ventilator associated pneumonia. Cisapride, even with the patient in the
            semirecumbent position, did not completely prevent gastric content
            aspiration.