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