Anushka Warusevitane1, Dumin Karunatilake2, Julius Sim2, Frank Lally2, Christine Roffe2. 1. From the Stoke Stroke Research Group, University Hospital of North Staffordshire (A.W., C.R.), Stroke Services, Taunton and Somerset NHS Trust (D.K.), Health Services Research Unit (J.S., C.R.), and Institute for Science and Technology in Medicine (F.L., C.R.), Keele University, Staffordshire, United Kingdom. anushka.warusevitane@uhns.nhs.uk. 2. From the Stoke Stroke Research Group, University Hospital of North Staffordshire (A.W., C.R.), Stroke Services, Taunton and Somerset NHS Trust (D.K.), Health Services Research Unit (J.S., C.R.), and Institute for Science and Technology in Medicine (F.L., C.R.), Keele University, Staffordshire, United Kingdom.
Abstract
BACKGROUND AND PURPOSE: Pneumonia is a major cause of mortality and morbidity in patients with stroke fed via nasogastric tubes and may be because of vomiting and gastro-oesophageal regurgitation. The aim of the study was to assess whether regular treatment with metoclopramide, a D2-receptor antagonist with antiemetic and gastric prokinetic actions, could reduce the rate of aspiration and pneumonia. METHODS:Patients with no signs of pneumonia within 7 days of stroke onset and 48 hours of insertion of a nasogastric tube were recruited into a double-blind randomized placebo-controlled trial. Participants received metoclopramide 10 mg or placebo 3× daily via the nasogastric tube for 21 days or until nasogastric feeds were discontinued. Clinical signs of pneumonia were recorded daily. Pneumonia was diagnosed if the patient had relevant clinical signs, high inflammatory markers, and new infiltrates on the chest radiograph. RESULTS:Sixty patients (mean age, 78 years; 38 women; mean National Institutes for Health Stroke Scale score, 19.25) were randomized in a 1:1 ratio. There were significantly more episodes of pneumonia in the placebo group than in the metoclopramide group (rate ratio, 5.24; P<0.001). There were also significant differences in favor of metoclopramide in the rate of aspiration, oxygen saturation, highest inflammatory markers, and National Institutes for Health Stroke Scale. There was no significant difference in mortality between the groups. CONCLUSIONS: This study suggests that metoclopramide may reduce the rate of pneumonia and may improve other clinical outcomes in patients with subacute stroke fed via nasogastric tube. These findings need to be confirmed in larger randomized and blinded trials. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrialsregister.eu. EudraCT no: 2006-002570-22, URL: http://www.controlled-trials.com/ISRCTN18034911/18034911.
RCT Entities:
BACKGROUND AND PURPOSE:Pneumonia is a major cause of mortality and morbidity in patients with stroke fed via nasogastric tubes and may be because of vomiting and gastro-oesophageal regurgitation. The aim of the study was to assess whether regular treatment with metoclopramide, a D2-receptor antagonist with antiemetic and gastric prokinetic actions, could reduce the rate of aspiration and pneumonia. METHODS:Patients with no signs of pneumonia within 7 days of stroke onset and 48 hours of insertion of a nasogastric tube were recruited into a double-blind randomized placebo-controlled trial. Participants received metoclopramide 10 mg or placebo 3× daily via the nasogastric tube for 21 days or until nasogastric feeds were discontinued. Clinical signs of pneumonia were recorded daily. Pneumonia was diagnosed if the patient had relevant clinical signs, high inflammatory markers, and new infiltrates on the chest radiograph. RESULTS: Sixty patients (mean age, 78 years; 38 women; mean National Institutes for Health Stroke Scale score, 19.25) were randomized in a 1:1 ratio. There were significantly more episodes of pneumonia in the placebo group than in the metoclopramide group (rate ratio, 5.24; P<0.001). There were also significant differences in favor of metoclopramide in the rate of aspiration, oxygen saturation, highest inflammatory markers, and National Institutes for Health Stroke Scale. There was no significant difference in mortality between the groups. CONCLUSIONS: This study suggests that metoclopramide may reduce the rate of pneumonia and may improve other clinical outcomes in patients with subacute stroke fed via nasogastric tube. These findings need to be confirmed in larger randomized and blinded trials. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrialsregister.eu. EudraCT no: 2006-002570-22, URL: http://www.controlled-trials.com/ISRCTN18034911/18034911.
Authors: Annastazia E Learoyd; Lisa Woodhouse; Laurence Shaw; Nikola Sprigg; Daniel Bereczki; Eivind Berge; Valeria Caso; Hanne Christensen; Ronan Collins; Anna Czlonkowska; Anwar El Etribi; Tracy D Farr; John Gommans; Ann-Charlotte Laska; George Ntaios; Serefnur Ozturk; Stuart J Pocock; Kameshwar Prasad; Joanna M Wardlaw; Kevin C Fone; Philip M Bath; Rebecca C Trueman Journal: Transl Stroke Res Date: 2017-07-27 Impact factor: 6.829