From the Guidelines
Yes, enteral nutrition can be administered concurrently with Nimbex (cisatracurium) infusion.
Rationale
- The use of neuromuscular blocking agents (NMBAs) like cisatracurium does not directly impair gastric emptying or gut absorption, as evidenced by a study using the paracetamol absorption technique 1.
- Factors such as prolonged immobility, opioid use, and fluid imbalances are more likely to decrease intestinal motility, rather than the NMBA itself.
- Evaluating the underlying critical illness is crucial in determining whether the patient has a functional gastrointestinal tract, independent of NMBA use 1.
- Therefore, enteral nutrition can be administered concurrently with cisatracurium infusion, but clinicians should be vigilant in assessing bowel function and tolerance of enteral nutrition.
- It is essential to consider the individual patient's condition and the potential effects of other factors on gastrointestinal function, rather than making assumptions based on NMBA use alone 1.
From the Research
Enteral Nutrition Administration with Nimbex (Cisatracurium) Infusion
- Enteral nutrition (EN) can be administered concurrently with Nimbex (cisatracurium) infusion, as suggested by a retrospective study 2 that found no statistically significant difference in emesis, new-onset abdominal pain, or bowel ischemia between patients receiving cisatracurium with EN and those receiving EN alone.
- However, the study did find more patients with new or worsening abdominal distention and occurrences of gastric residual volume (GRV) > 300 ml in the group receiving cisatracurium 2.
- Another study compared the efficacy and tolerance of brand-name (Nimbex®) and generic (Cisatrex®) cisatracurium in mechanically ventilated critically ill patients, but did not specifically address the administration of EN with cisatracurium infusion 3.
- Methods of EN administration, including continuous, cyclic, intermittent, and bolus feeding, can be used in critically ill patients, but the optimal method is still a topic of debate 4, 5, 6.
- Pump-assisted continuous feeding is generally acceptable for critically ill patients to prevent EN-related complications, but intermittent or bolus feeding may be more beneficial for muscle protein synthesis and gastrointestinal hormone secretion 4, 5, 6.