***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE The purpose of this study was to determine if intravenous push metoclopramide would facilitate immediate transpyloric passage of a small-bore feeding tube without fluoroscopy or endoscopy . DESIGN Prospect i ve , r and omized trial . PATIENTS One hundred five medical and surgical ICU patients at a community teaching hospital . INTERVENTIONS Patients were r and omized to receive 10 mg of metoclopramide 10 min before tube insertion or no medication . MEASUREMENT Successful placement was stated as radiologically verified transduodenal tube location . RESULTS A 54 % success rate was shown with administration of the drug with 46 % success for the control . Chi square analysis of the success rate showed no significant relationship between administration of metoclopramide and successful tube placement ( p = 0.38 ) . Increasing years of physician training was the only variable associated with successful placement ( p = 0.003 ) . No association was found between successful tube placement and presence of endotracheal tube , tracheostomy , or cervical immobility , nor any interaction of metoclopramide with these variables . CONCLUSION Intravenous metoclopramide , 10 mg , administered 10 min prior to intubation with a small-bore feeding tube ( 10F ) , was ineffective in facilitating transpyloric intubation BACKGROUND To determine whether administration of erythromycin ( E ) could facilitate passage of a nasoenteric feeding tube into the duodenum for postpyloric feedings , this r and omized , double-blind , placebo-controlled trial was performed . METHODS Fifty-seven patients were accrued from the surgical intensive care units ( ICUs ) of a tertiary-care university hospital . Patients enrolled were categorized as to the presence or absence of diabetes mellitus ( DM ) . Those patients without DM were then subdivided into those with normal or depressed mental status . The three groups , normal ( NMS ) , depressed mental status ( DMS ) , or diabetes mellitus ( DM ) , were then r and omized independently to receive either E or placebo ( P ) , followed by blind placement of a feeding tube . Tube placement was verified by an abdominal radiograph . RESULTS Overall , the rate of postpyloric placement was 61 % ( 19/31 ) in the E group , significantly better than 35 % ( 9/26 ) in the P group ( p < .05 ) . In patients with NMS , the success rate with E was improved ( 64 % , 9/14 ) compared with that with P ( 9 % , 1/11 ) ( p < .0005 ) . In the DMS group , there was a 50 % success rate ( 6/12 ) with E versus 63 % ( 5/8 ) with P ( not significant [ NS ] ) . In the DM group , 80 % ( 4/5 ) of the patients had placement of the tube in the duodenum with E and 43 % ( 3/7 ) with P ( NS ) . CONCLUSIONS These data suggest that , overall , E is effective in facilitating placement of a nasoenteric feeding tube into the duodenum in ICU patients . It is clearly beneficial in those patients with normal mental status and may be useful in patients with diabetes mellitus BACKGROUND Risk factors for nosocomial pneumonia , such as gastro-oesophageal reflux and subsequent aspiration , can be reduced by semirecumbent body position in intensive-care patients . The objective of this study was to assess whether the incidence of nosocomial pneumonia can also be reduced by this measure . METHODS This trial was stopped after the planned interim analysis . 86 intubated and mechanically ventilated patients of one medical and one respiratory intensive-care unit at a tertiary-care university hospital were r and omly assigned to semirecumbent ( n=39 ) or supine ( n=47 ) body position . The frequency of clinical ly suspected and microbiologically confirmed nosocomial pneumonia ( clinical plus quantitative bacteriological criteria ) was assessed in both groups . Body position was analysed together with known risk factors for nosocomial pneumonia . FINDINGS The frequency of clinical ly suspected nosocomial pneumonia was lower in the semirecumbent group than in the supine group ( three of 39 [ 8 % ] vs 16 of 47 [ 34 % ] ; 95 % CI for difference 10.0 - 42.0 , p=0.003 ) . This was also true for microbiologically confirmed pneumonia ( semirecumbent 2/39 [ 5 % ] vs supine 11/47 [ 23 % ] ; 4.2 - 31.8 , p=0.018 ) . Supine body position ( odds ratio 6.8 [ 1.7 - 26.7 ] , p=0.006 ) and enteral nutrition ( 5.7 [ 1.5 - 22.8 ] , p=0.013 ) were independent risk factors for nosocomial pneumonia and the frequency was highest for patients receiving enteral nutrition in the supine body position ( 14/28 , 50 % ) . Mechanical ventilation for 7 days or more ( 10.9 [ 3.0 - 40.4 ] , p=0.001 ) and a Glasgow coma scale score of less than 9 were additional risk factors . INTERPRETATION The semirecumbent body position reduces frequency and risk of nosocomial pneumonia , especially in patients who receive enteral nutrition . The risk of nosocomial pneumonia is increased by long- duration mechanical ventilation and decreased consciousness OBJECTIVES To investigate the absorption of the gastrokinetic drug , cisapride , and effect of cisapride on gastric emptying in critically ill patients ; and to assess the usefulness of clinical signs of gastric emptying . DESIGN Prospect i ve , r and omized , controlled study . SETTING Medical/surgical/trauma intensive care unit ( ICU ) in a university hospital . PATIENTS Twenty-seven consecutively enrolled patients , aged 18 to 65 yrs , with normal hepatic and renal biochemistry who were not receiving enteral nutrition and who had no contraindications to enteral nutrition . These patients were expected to stay in the ICU for at least 4 days . INTERVENTIONS Patients were r and omized to receive either placebo or rectal cisapride , 60 mg initially followed by two doses of 30 mg at 8-hr intervals . MEASUREMENTS AND MAIN RESULTS Gastric emptying was estimated , using acetaminophen absorption on day 1 of the study . Placebo or cisapride was administered and a second acetaminophen absorption test for gastric emptying was carried out on day 2,24 hrs after the first test . Four patients were excluded because of incomplete data . Statistical analysis was performed , using the area under the acetaminophen absorption curve from 0 to 60 mins as the primary measure of gastric emptying . There was no significant change in the area under the acetaminophen absorption curve from 0 to 60 mins from day 1 to day 2 in patients who received placebo or cisapride . Using the combination of the time to maximum acetaminophen concentration ( < or = 30 mins ) with a maximum concentration ( > 12 mg/L ) to define " normal " emptying , on day 1 , four of the 11 placebo patients had the " normal " gastric emptying , and by day 2 , five patients fulfilled this criterion . Before administration of cisapride , four of the 12 patients fulfilled this criterion , whereas nine fulfilled the criterion after receiving cisapride . There was a large variation in gastric emptying from day 1 to day 2 ; a power calculation suggests that approximately 150 patients would have to be studied to determine the effect of cisapride . There was no correlation between gastric emptying and the volume of gastric aspirate or the presence of bowel sounds . Plasma cisapride concentrations 4 hrs after the third dose , during the second acetaminophen absorption test , averaged 53 ng/mL ( range 20 to 111 ) . CONCLUSIONS Rectal cisapride in the dose given achieved average plasma concentrations similar to those concentrations achieved in healthy subjects after 30 mg of cisapride rectally . There is a large variation in gastric emptying from one day to the next and large numbers of patients are required to determine if cisapride administration improves early gastric emptying in critically ill patients . The volume of gastric aspirate and the presence of bowel sounds do not correlate with gastric emptying Objective : To determine whether metoclopramide prevents nosocomial pneumonia in intensive care unit ( ICU ) patients receiving enteral feeding by a nasogastric tube . Design : Prospect i ve , r and omized , controlled trial . Setting : ICU of a university hospital . Patients : A total of 305 consecutive patients requiring placement of a nasogastric tube for > 24 hrs . Interventions : Patients were r and omized to receive either 10 mg of metoclopramide or placebo at 8‐hr intervals through the nasogastric tube . Measurements and Main Results : A total of 174 patients received placebo and 131 received metoclopramide .  Baseline characteristics in the two treatment groups were comparable . Of the 305 patients , 46 developed nosocomial pneumonia , which was 24 patients ( 13.7 % ) in the placebo group and 22 ( 16.8 % ) in the metoclopramide group ( p > .05 ) . Patients in the placebo group developed pneumonia earlier than patients receiving metoclopramide ( 4.46 ± 1.72 days [ mean ± SD[rsqb ] after ICU admission compared with 5.95 ± 1.78 days ; p = .006 ) . Subgroup analysis showed that metoclopramide did not reduce the frequency rate of pneumonia in patients with tracheal intubation ( 19 [ 25.3 % ] of 75 patients receiving metoclopramide vs. 21 [ 21.2 % ] of 99 patients receiving placebo ) or those receiving mechanical ventilation ( 17 [ 25.6 % ] of 58 patients receiving metoclopramide vs. 20 [ 29.3 % ] of 78 patients receiving placebo ) . The mortality rate also did not differ in the two treatments groups ( 56 % in the metoclopramide group vs. 53 % in the placebo group ; p > .05 ) . Conclusions : Although metoclopramide delayed the development of nosocomial pneumonia , it did not decrease its frequency rate and had no effect on the mortality rate in critically ill patients receiving nasogastric enteral feeding OBJECTIVE To evaluate the effect of the erythromycin derivative EM523L on gastric emptying and postpr and ial insulin requirement in insulin-dependent diabetic patients with severe gastroparesis . RESEARCH DESIGN AND METHODS In six IDDM patients with severe gastroparesis ( two men and four women , mean age 44.5 years [ range 36–53 ] ) , the insulin infusion pattern during feedback control with an artificial endocrine pancreas device ( Biostator ) after intake of a test meal , the retention rate of residual isotope ( 99mTc-labelled Sn-colloid ) in the stomach , and the time-concentration curve of plasma acetaminophen as the marker for liquid emptying were studied with EM523L or a control placebo RESULTS Time courses of insulin infusion rates peaked within 120 min after intake of the test meal in the EM523L phase , whereas no apparent peak rates were observed in the control phase . The total amount of insulin required in the first 90 min postpr and ial was significantly greater in the EM523L phase than in the control phase . EM523L significantly decreased the residual isotope ratio in the stomach at ≥50 min postpr and ial and increased the plasma acetaminophen concentrations at 30–120 min postpr and ial , compared with respective values in the control phase . CONCLUSIONS Preliminary results obtained from a small number of patients suggest that EM523L or erythromycin analogs , which have agonistic activity to motilin receptors as well as no antibacterial effect , may be useful to accelerate gastric emptying and improve insulin requirement patterns , thereby establishing more stable glycemic control BACKGROUND The purpose of this study was to compare gastrointestinal tolerance to two enteral feeding protocol s in critically ill patients . METHODS A prospect i ve , r and omized controlled trial , that involved 96 consecutive patients expected to stay in the intensive care unit for > or =3 days and who had no contraindications to enteral feeding . The patients were r and omized to either the current protocol ( group I ; gastric residual volume threshold , 150 mL , optional prokinetic ) or proposed feeding protocol ( group II ; gastric residual volume threshold 250 mL , m and atory prokinetic ) .  Gastrointestinal intolerance was recorded as episodes of high gastric residual volume , emesis , or diarrhea . The time to reach the goal rate of feeding and the percentage of nutritional requirements received during the study period were also recorded . RESULTS Nineteen of 36 patients ( 19/36 = 0.53 ) in group I had one or more episodes of high gastric residual volume , compared with 10 of 44 patients ( 10/44 = 0.23 ) in group II ( p < . 
    Output:
    
Although there are conflicting studies , the larger and more method ologically robust studies suggest that metoclopramide has no effect on feeding tube placement .
As a class of drugs , promotility agents appear to have a beneficial effect on gastrointestinal motility in critically ill patients .
A one-time dose of erythromycin may facilitate small-bowel feeding tube insertion .
Administration of metoclopramide appears to increase physiologic indexes of gastrointestinal transit and feeding tolerance .