Use of Prokinetic Agents in Adult <scp>ICU</scp> Patients: An International Inception Cohort Study ( <scp>PATIENCE</scp> )

BACKGROUND: Feeding intolerance is common in intensive care unit (ICU) patients, but evidence supporting prokinetic use is limited. We aimed to provide international epidemiological data on the use of prokinetic agents in adult ICU patients and to explore potential associations with patient-important outcomes. METHODS: We conducted an inception cohort study between August 2024 and March 2025 in acutely admitted ICU patients in 56 ICUs across 11 countries. The primary outcome was the proportion of patients receiving prokinetic agents. Secondary outcomes included associations with baseline characteristics, serious adverse events (SAEs), days alive out of ICU/hospital, days alive without life support and 90-day mortality. Associations with SAEs, baseline characteristics and mortality were assessed using pre-specified Cox regression models, while other secondary outcomes were evaluated using adjusted linear regression. All models were adjusted for country, severity of illness, number of comorbidities, surgery and ICU admission type. RESULTS: Among 1440 ICU patients (median age 64 years, 56.9% male), 187 (13.0%; 95% confidence interval [CI] 11.3-14.8) received prokinetic agents during ICU stay, most commonly metoclopramide (65%). Prior abdominal surgery was associated with the initiation of prokinetic agents (hazard ratio [HR] 1.81; 95% CI 1.17-2.79). Use of prokinetic agents was statistically significantly associated with a higher hazard of experiencing a SAE (HR 1.9; 95% CI 1.3-2.8), fewer days alive out of ICU (mean difference [MD] -7.6 days; 95% CI, -13.4 to -2.2) and hospital (-13.5 days; 95% CI -18.7 to -8.4), but not with 90-day mortality (HR 0.62; 95% CI 0.3-1.2). CONCLUSIONS: Prokinetic agents were used in 13% of ICU patients, most commonly metoclopramide and more often in those with prior abdominal surgery. Prokinetic use was associated with a higher hazard of experiencing SAEs and fewer days alive out of hospital/ICU.

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Journal
Acta Anaesthesiologica Scandinavica
Published
2026-06-24
DOI
https://doi.org/10.1111/aas.70290
Primary Topic
Enhanced Recovery After Surgery
Type
article
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article

Use of Prokinetic Agents in Adult ICU Patients: An International Inception Cohort Study ( PATIENCE )

Anca Balintescu, Olena Breum, Peter Martin Hansen, Mikkel Bak et al.
Acta Anaesthesiologica Scandinavica
Enhanced Recovery After Surgery
article

Use of Prokinetic Agents in Adult ICU Patients: An International Inception Cohort Study ( PATIENCE )

Anca Balintescu, Olena Breum, Peter Martin Hansen, Mikkel Bak, Jonas Elmer Pedersen, Anne Craveiro Brøchner, Marcelina Czok, Rawabi M. Alsayer, Laura Rindom Krogsgaard, E Hardman, Therese Simonsen Straarup, Jaanus Korjas, Fadah A. Alanazi, Jens Michelsen, Mette Krag, Theis Skovsgaard Itenov, Hans-Erik Ehrlich, Vera Crone, Tobias Browall Krogh, Oskar Appelberg, Kadri Tamme, Lise Skyttegaard Balkert, Wojciech Szczeklik, Anne Sofie Andreasen, Bartosz Kudliński, Morten Hylander Møller, Hakeam A. Hakeam, Andreas Bender Jonsson, Paweł Zatorski, Morten H. Bestle, Hanna Baran, Olof Wall, Marisa Onrust, Björn Brand, Peter Buhl Hjortrup, Marlies Ostermann, Ola Friman, Maj‐Brit Nørregaard Kjær, Anders Granholm, Liivi Maddison, Tino Severinsen, Annika Reintam Blaser, Ville Jalkanen, Frederik Keus, Anna Kluzik, Anne‐Marie Gellert Bunzel, Zainab Al Duhailib, Matti Reinikainen, Bodil Steen Rasmussen, Talvikki Koskue, Mathias Thomsen, Ricard Ferrer, K. Belkhouja, J Hästbacka, Oliwia Doroba, Sandra Lindkvist-Viggers, Abdulrahman Al‐Fares, Christian Gade Nissen, Carmen A. Pfortmueller, S Bialka, W Alhazzani, Osama Ahmed Elfaki, Daniel Törnberg, Eva Poulsen, Zemira Engbakken, Mohammed Alshahrani, Reile Juhanson, Kenneth van Smaalen, Anders Perner, Kristian Reinhold Jauho, Rakan Aldhahri, Seraina‐Flavia Buholzer, Christopher Torp, Marleena Finni, Ali Alahmari, Camilla Tageby Nielsen, David S. Pérez, Christian Juhl Svendsen, Per Lund Petersen, Pawel Nowak
article en

Abstract

BACKGROUND: Feeding intolerance is common in intensive care unit (ICU) patients, but evidence supporting prokinetic use is limited. We aimed to provide international epidemiological data on the use of prokinetic agents in adult ICU patients and to explore potential associations with patient-important outcomes. METHODS: We conducted an inception cohort study between August 2024 and March 2025 in acutely admitted ICU patients in 56 ICUs across 11 countries. The primary outcome was the proportion of patients receiving prokinetic agents. Secondary outcomes included associations with baseline characteristics, serious adverse events (SAEs), days alive out of ICU/hospital, days alive without life support and 90-day mortality. Associations with SAEs, baseline characteristics and mortality were assessed using pre-specified Cox regression models, while other secondary outcomes were evaluated using adjusted linear regression. All models were adjusted for country, severity of illness, number of comorbidities, surgery and ICU admission type. RESULTS: Among 1440 ICU patients (median age 64 years, 56.9% male), 187 (13.0%; 95% confidence interval [CI] 11.3-14.8) received prokinetic agents during ICU stay, most commonly metoclopramide (65%). Prior abdominal surgery was associated with the initiation of prokinetic agents (hazard ratio [HR] 1.81; 95% CI 1.17-2.79). Use of prokinetic agents was statistically significantly associated with a higher hazard of experiencing a SAE (HR 1.9; 95% CI 1.3-2.8), fewer days alive out of ICU (mean difference [MD] -7.6 days; 95% CI, -13.4 to -2.2) and hospital (-13.5 days; 95% CI -18.7 to -8.4), but not with 90-day mortality (HR 0.62; 95% CI 0.3-1.2). CONCLUSIONS: Prokinetic agents were used in 13% of ICU patients, most commonly metoclopramide and more often in those with prior abdominal surgery. Prokinetic use was associated with a higher hazard of experiencing SAEs and fewer days alive out of hospital/ICU.

Acta Anaesthesiologica ScandinavicaVol. 70(7)
University of Szczecin (PL), University of Bern (CH), Poznan University of Medical Sciences (PL), University of Copenhagen (DK), Jagiellonian University (PL), Ministry of Defence (GB), University Medical Center Groningen (NL), Karolinska University Hospital (SE), Riyadh Armed Forces Hospital (SA), University of Helsinki (FI), Alfaisal University (SA), University of Lucerne (CH), Medical University of Silesia (PL), University of Eastern Finland (FI), University of Southern Denmark (DK), Guy's and St Thomas' NHS Foundation Trust (GB), Medical University of Warsaw (PL), Aalborg University Hospital (DK), Helsinki University Hospital (FI), King Faisal Specialist Hospital & Research Centre (SA), University Hospital of Bern (CH), Frederiksberg Hospital (DK), King Fahd Hospital of the University (SA), Odense University Hospital (DK), Herlev Hospital (DK), Hvidovre Hospital (DK), Danderyds sjukhus (SE), Tartu University Hospital (EE), Aarhus University Hospital (DK), Copenhagen University Hospital (DK), Gentofte Hospital (DK), Rigshospitalet (DK), Amiri Hospital (KW), Karolinska Institutet (SE), North Denmark Region (DK), Zealand University Hospital (DK), Regionshospitalet Viborg (DK), Vejle Sygehus (DK), Kuopio University Hospital (FI), North Estonia Medical Centre (EE), East Tallinn Central Hospital (EE), Glanrhyd Hospital (GB), King Fahd Armed Forces Hospital (SA), King Fahd Military Medical Complex (SA), Armed Forces Hospital (SA), Centre for Research in Intensive Care (DK), Region of Southern Denmark (DK), Kolding Hospital (DK), Tampere University Hospital (FI), Vall d'Hebron Hospital Universitari (ES), Ministry of Health (SA), Ministry of Health (KW), Päijät-Hämeen Keskussairaala (FI), Tampere University (FI), Holbæk Sygehus (DK), Zealand University Hospital Køge (DK), Regional Hospital Randers (DK), Svendborg Sygehus (DK), Hospital District of Helsinki and Uusimaa (FI), University of Zielona Góra (PL), University of Tartu (EE), Imam Abdulrahman Bin Faisal University (SA), Aalborg University (DK)
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Enhanced Recovery After Surgery
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