Abdominal Massage May Facilitate Gastric Emptying in Patients With Impaired Motility

Yael Waknine

October 20, 2004

Oct. 20, 2004 — Abdominal massage improves the gastric emptying rate in critically ill patients with impaired gastric motility who are receiving enteral nutrition, according to the results of a randomized, prospective, two-day study presented at the 17th annual congress of the European Society of Intensive Care Medicine in Berlin, Germany.

Gastric emptying is often delayed in critically ill patients and has been associated with decreased nutrition and increased risks of gastric colonization and aspiration-related pneumonia, according to Regine Bastin, kinesitherapist of the intensive care unit at the Université Libre de Bruxelles's Hôpital Erasme in Brussels, Belgium.

According to Ms. Bastin, massage therapy is a commonly used, noninvasive method of relieving constipation and has been shown to shorten the duration of postoperative ileus.

Ms. Bastin and colleagues assessed the effect of massage on gastric emptying in 19 critically ill adult patients having received enteral feeding by nasogastric tube for a minimum of 24 hours. Patients were randomized to receive a massage on day 2 after enrollment (n = 11) or no massage (n = 8).

The massage consisted of éffleurage to relax the abdominal muscles, followed by pétrissage from the cecum to the descending colon until a softening was felt, and return to effleurage, Ms. Bastin said.

Gastric emptying was assessed on days 1 and 2 using the paracetamol absorption test, in which 2 g acetaminophen (Paracetamol) was dissolved in 150 mL water and administered by nasogastric tube. Plasma concentrations of acetaminophen were taken at baseline and at regular intervals over a period of one hour, and then plotted compared with time. "Paracetamol is absorbed just after passage through the pylorus, so if you calculate the area under the curve during one hour (AUC60), you can obtain an assessment of gastric emptying," noted Ms. Bastin.

Baseline gastric emptying rates (AUC60) were similar on days 1 and 2 within the massage group (644 ±188 mmol/min/L vs 820 ± 172 mmol/min/L) and the control group (942 ± 275 mmol/min/L vs 899 ±235 mmol/min/L).

Patients with initial gastric residual volume greater than 150 mL (n = 10) had significantly lower gastric emptying rates compared with those having gastric residual volume less than 150 mL (411 ± 167 mmol/min/L vs 1144 ± 210 mmol/min/L; P < .01).

In patients with delayed gastric emptying, massage increased the rate of gastric emptying compared with baseline (510 ±143 mmol/min/L vs 199 mmol/min/L; P = .06).

"Massage is a noninvasive technique that merits scientific investigation to quantify its positive effects versus placebo and provide an argument in favor of its use," concluded Ms. Bastin. "If we can improve gastric emptying in patients receiving enteral nutrition simply with massage, it will probably be very useful."

The authors report no pertinent financial disclosures.

ESICM 17th Annual Congress: Abstract 312. Presented Oct. 12, 2004.

Reviewed by Gary D. Vogin, MD


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