In adults, promotility agents should be considered under which circumstance?

• A. Immediately after initiating feeding regardless of GRV.
• B. When there are persistently elevated GRVs.
• C. After 48 hours with normalized GRV.
• D. Only in patients with GERD.

Answer: (B)

Promotility therapy in adults is considered when there's evidence of gastric emptying delay, most clearly shown by persistently elevated gastric residual volumes during enteral feeding. If GRV remains high despite initial measures to optimize feeding, a prokinetic agent can help by enhancing gastric contractions and accelerating emptying, which improves tolerance and reduces aspiration risk. This approach isn’t appropriate to start immediately after feeding begins regardless of GRV, isn’t limited to GERD, and wouldn’t be used only after GRV has normalized. Clinically, persistently elevated GRV on repeated checks often triggers consideration of a prokinetic.