LAUSR

Introduction In this issue of Intensive Care Medicine, Heyland et al. reported the results of the PROMOTE Trial [1]. In this international multicenter (20 sites, 4 countries) randomized double-blind study, 120 critically ill patients who had enteral feeding intolerance (EFI) were randomized to receive ulimorelin or metoclopramide for 5 days. A volume-based feeding protocol was employed, with a starting feeding rate of 40 mL/h and maximum rate of 150 mL/h. Gastric residual volumes (GRV) were measured every 6 h, and the feeding rate was increased if GRV was < 500 mL, and reduced if GRV was ≥ 500 mL; if GRV ≥ 500 mL persisted in two consecutive measurements with feeding 10 mL/h beyond day 1, the study drug was discontinued. The study found no difference between ulimorelin and metoclopramide in the primary endpoint of percentage of daily protein prescription (DPP) over 5 days of treatment. There were no differences in the secondary endpoints of feeding success, gastric emptying assessed by paracetamol absorption, incidence of recurrent EFI, vomiting or regurgitation, aspiration, and pulmonary infection. The study highlighted some uncertainties and the need for harmonization.