The Study of The Efficacy and Safety of Itopride in Feeding Intolerance of Critically-ill Patients Receiving Enteral Nutrition

Abstract

Enteral feeding intolerance is a frequent problem in the ICU and is associated with poor clinical outcomes leading to worse prognosis. Nowadays, prokinetic drugs have an established role as an effective treatment to improve EFI. However, the available prokinetics have uncertain efficacy and safety profiles. Itopride, is a prokinetic agent which is unique from the available prokinetics because of its dual mode of action as well as its tolerability and safety. Although GRV measurement provide a useful clinical endpoint in prokinetic drug studies, however, the current diagnostic tools for evaluating gastric emptying have technical limitations. USG is a non-invasive, inexpensive diagnostic test which provides information regarding most parameters of gastric motility. Despite the availability of numerous clinical practice guidelines focused on feeding critically ill patients, observational studies have consistently demonstrated significant gaps between guideline recommendations and actual nutrition practice. To determine the cause of the knowledge-practice gap, one potential approach is to identify barriers to providing optimal EN in the ICU. The current study was designed to determine the efficacy and safety of itopride in critically ill patients with EFI in comparison with metoclopramide. In addition, it tested the utility and applicability of USG to measure GRV in this population. Moreover, to understand the role of the clinical pharmacist in identifying the barriers to applying optimum enteral nutritional practices from the perspective of critical care providers through conducting the BEFIP questionnaire.