title: Metoclopramide or domperidone improves post-pyloric placement of spiral nasojejunal tubes in critically ill patients: a prospective, multicenter, open-label, randomized, controlled clinical trial.
abstract: BACKGROUND
  The use of prokinetic agents on post-pyloric placement of spiral nasojejunal tubes is controversial. The aim of the present study was to examine if metoclopramide or domperidone can increase the success rate of post-pyloric placement of spiral nasojejunal tubes.
  
  
  METHODS
  A multicenter, open-label, randomized, controlled trial was conducted in seven hospitals in China between April 2012 and February 2014. Patients admitted to the intensive care unit and requiring enteral nutrition for more than three days were randomly assigned to the metoclopramide, domperidone or control groups (1:1:1 ratio). The primary outcome was defined as the success rate of post-pyloric placement of spiral nasojejunal tubes, assessed 24 hours after initial placement. Secondary outcomes included success rate of post-D1, post-D2, post-D3 and proximal jejunum placement and tube migration distance. Safety of the study drugs and the tubes during the entire study period were recorded.
  
  
  RESULTS
  In total, 307 patients were allocated to the metoclopramide (n = 103), domperidone (n = 100) or control group (n = 104). The success rate of post-pyloric placement after 24 hours in the metoclopramide, domperidone and control groups was 55.0%, 51.5% and 27.3%, respectively (P = 0.0001). Logistic regression analysis identified the use of prokinetic agents, Acute Physiology and Chronic Health Evaluation (APACHE) II score <20, Sequential Organ Failure Assessment (SOFA) score <12 and without vasopressor as independent factors influencing the success rate of post-pyloric placement. No serious drug-related adverse reaction was observed.
  
  
  CONCLUSIONS
  Prokinetic agents, such as metoclopramide or domperidone, are effective at improving the success rate of post-pyloric placement of spiral nasojejunal tubes in critically ill patients.
  
  
  BACKGROUND
  Chinese Clinical Trial Registry ChiCTR-TRC-12001956 . Registered 21 February 2012.
authors.affiliation: Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, PR China. qhubei@hotmail.com.
authors.forename: Bei
authors.initials: B
authors.lastname: Hu
authors.affiliation: Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, PR China. yeheng@139.com.
authors.forename: Heng
authors.initials: H
authors.lastname: Ye
authors.affiliation: Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, PR China. suncheng2008@139.com.
authors.forename: Cheng
authors.initials: C
authors.lastname: Sun
authors.affiliation: Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, PR China. zychen86@126.com.
authors.forename: Yichen
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Critical Care Medicine, The First Affiliated Hospital of Guangdong Pharmaceutical University, 19 Nonglinxia Road, Guangzhou, 510080, Guangdong, PR China. minglaolzg@sina.com.
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Lao
authors.affiliation: Department of Critical Care Medicine, Jiangmen Wuyi Traditional Chinese Medicine Hospital, 30 Huayuandong Road, Jiangmen, 529000, Guangdong, PR China. doctor.two.w@163.com.
authors.forename: Fanghong
authors.initials: F
authors.lastname: Wu
authors.affiliation: Department of Critical Care Medicine, Guangdong Armed Police Hospital, 106 Yanling Road, Guangzhou, 510507, Guangdong, PR China. zhaohui998@126.com.
authors.forename: Zhaohui
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Critical Care Medicine, The First Affiliated Hospital of Shantou University Medical Collage, 57 Changping Road, Shantou, 515041, Guangdong, PR China. hlx1236@126.com.
authors.forename: Linxi
authors.initials: L
authors.lastname: Huang
authors.affiliation: Department of Critical Care Medicine, Guangdong Yunfu People's Hosipital, 120 Huanshidong Road, Yunfu, 527300, Guangdong, PR China. quchangchun369@163.com.
authors.forename: Changchun
authors.initials: C
authors.lastname: Qu
authors.affiliation: Department of Critical Care Medicine, Cancer Center of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou, 510095, Guangdong, PR China. 924563760@qq.com.
authors.forename: Lewu
authors.initials: L
authors.lastname: Xian
authors.affiliation: Department of Critical Care Medicine, The First Affiliated Hospital of Guangdong Pharmaceutical University, 19 Nonglinxia Road, Guangzhou, 510080, Guangdong, PR China. purifiedwu@tom.com.
authors.forename: Hao
authors.initials: H
authors.lastname: Wu
authors.affiliation: Department of Critical Care Medicine, Jiangmen Wuyi Traditional Chinese Medicine Hospital, 30 Huayuandong Road, Jiangmen, 529000, Guangdong, PR China. jiaoyingjie212@163.com.
authors.forename: Yingjie
authors.initials: Y
authors.lastname: Jiao
authors.affiliation: Department of Critical Care Medicine, Guangdong Armed Police Hospital, 106 Yanling Road, Guangzhou, 510507, Guangdong, PR China. jinlyn139@163.com.
authors.forename: Junling
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Critical Care Medicine, The First Affiliated Hospital of Shantou University Medical Collage, 57 Changping Road, Shantou, 515041, Guangdong, PR China. swxcjy@126.com.
authors.forename: Juyu
authors.initials: J
authors.lastname: Cai
authors.affiliation: Department of Critical Care Medicine, Guangdong Yunfu People's Hosipital, 120 Huanshidong Road, Yunfu, 527300, Guangdong, PR China. 13927114361@163.com.
authors.forename: Weiying
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Cardiovascular Epidemiology, Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, PR China. 304818029@qq.com.
authors.forename: Zhiqiang
authors.initials: Z
authors.lastname: Nie
authors.affiliation: Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, PR China. zyliu@163.com.
authors.forename: Zaiyi
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, PR China. gghccm@163.com.
authors.forename: Chunbo
authors.initials: C
authors.lastname: Chen
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000932:Antiemetics / Q000627:therapeutic use*; D016638:Critical Illness; D004294:Domperidone / Q000627:therapeutic use*; D004750:Enteral Nutrition / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D011706:Pyloric Antrum; D055815:Young Adult
chemical_list: D000932:Antiemetics; D004294:Domperidone; D008787:Metoclopramide