The efficacy and safety of prokinetics in critically ill adults receiving gastric feeding tubes: A systematic review and meta-analysis

PLoS One. 2021 Jan 11;16(1):e0245317. doi: 10.1371/journal.pone.0245317. eCollection 2021.


Background: Intolerance to gastric feeding tubes is common among critically ill adults and may increase morbidity. Administration of prokinetics in the ICU is common. However, the efficacy and safety of prokinetics are unclear in critically ill adults with gastric feeding tubes. We conducted a systematic review to determine the efficacy and safety of prokinetics for improving gastric feeding tube tolerance in critically ill adults.

Methods: Randomized controlled trials (RCTs) were identified by systematically searching the Medline, Cochrane and Embase databases. Two independent reviewers extracted the relevant data and assessed the quality of the studies. We calculated pooled relative risks (RRs) for dichotomous outcomes and the mean differences (MDs) for continuous outcomes with the corresponding 95% confidence intervals (CIs). We assessed the risk of bias using the Cochrane risk-of-bias tool and used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to rate the quality of the evidence.

Results: Fifteen RCTs met the inclusion criteria. A total of 10 RCTs involving 846 participants were eligible for the quantitative analysis. Most studies (10 of 13, 76.92%) showed that prokinetics had beneficial effects on feeding intolerance in critically ill adults. In critically ill adults receiving gastric feeding, prokinetic agents may reduce the ICU length of stay (MD -2.03, 95% CI -3.96, -0.10; P = 0.04; low certainty) and the hospital length of stay (MD -3.21, 95% CI -5.35, -1.06; P = 0.003; low certainty). However, prokinetics failed to improve the outcomes of reported adverse events and all-cause mortality.

Conclusion: As a class of drugs, prokinetics may improve tolerance to gastric feeding to some extent in critically ill adults. However, the certainty of the evidence suggesting that prokinetics reduce the ICU or hospital length of stay is low. Prokinetics did not significantly decrease the risks of reported adverse events or all-cause mortality among critically ill adults.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Adult
  • Critical Illness*
  • Enteral Nutrition
  • Gastrointestinal Diseases / etiology
  • Humans
  • Intensive Care Units
  • Length of Stay
  • Pharmaceutical Preparations*
  • Publication Bias
  • Randomized Controlled Trials as Topic
  • Risk
  • Treatment Outcome


  • Pharmaceutical Preparations

Grant support

The study was supported by National Major Science and Technology Projects of China (Award Number: 2017ZX09304029, Recipient: Lingli Zhang), Sichuan Province Science and Technology Major Project (Award Number: 2017JY0067, Recipient: Lingli Zhang), the Major Project of Sichuan health committee (Award Number: 18ZD042, Recipient: Lingli Zhang), the Major Project of Sichuan Province Science and Technology in field of social development (Award Number: 20ZDYF3101, Recipient: Lingli Zhang), Sichuan Science and Technology Program (Award Number: 2020YJ0198, Recipient: Rong Peng), the Project of Education Department of Sichuan Province (Award Number: 18ZB0146, Recipient: Rong Peng), the Project of Chengdu Municipal Health Commission (Award Number: 2020088, Recipient: Rong Peng), the major Project of Affiliated Hospital of Chengdu University (Award Number: 2020YZZ04, Recipient: Rong Peng). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.