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.