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

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
Open Access CRIS of the University of Bern
Published
2026-06-25
DOI
https://doi.org/10.48620/98874
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.
Open Access CRIS of the University of Bern
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, Szymon Białka, Jonas Elmer Pedersen, Anne Craveiro Brøchner, Marcelina Czok, Rawabi M. Alsayer, Laura Rindom Krogsgaard, 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, Anne Sofie Andreasen, Bartosz Kudliński, Ville Jalkanen, Andreas Bender Jonsson, Paweł Zatorski, Hanna Baran, Olof Wall, Marisa Onrust, Björn Brand, Peter Buhl Hjortrup, Ola Friman, Maj‐Brit Nørregaard Kjær, Anders Granholm, Liivi Maddison, Tino Severinsen, Annika Reintam Blaser, Anna Kluzik, Anne‐Marie Gellert Bunzel, Zainab Al Duhailib, Matti Reinikainen, Bodil Steen Rasmussen, Talvikki Koskue, Mathias Thomsen, Ricard Ferrer, K. Belkhouja, Oliwia Doroba, Sandra Lindkvist-Viggers, Abdulrahman Al‐Fares, Waleed Alhazzani, Marlies Ostermann, Christian Gade Nissen, Carmen A. Pfortmueller, Osama Ahmed Elfaki, Hakeam A. Hakeam, Johanna Hästbacka, Wojciech Szczeklik, Daniel Törnberg, Eva Poulsen, Zemira Engbakken, Mohammed Alshahrani, Reile Juhanson, Kenneth van Smaalen, 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, Eric Keus, Morten Hylander Møller, Morten Heiberg Bestle, Anders Perner, Elizabeth Hardman
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.

Open Access CRIS of the University of Bern
Intensive Care Foundation (AU), Intensive Care Society (GB)
Good health and well-being
Openalex Percentile: Top 6%
Enhanced Recovery After Surgery
DOIOpen Access PDFOpenAlex
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