title: Effects of combined prokinetic administration on gastric emptying in critically ill patients.
abstract: OBJECTIVE
  Combination of prokinetic drugs with different mechanisms of action is frequently used when feeding intolerance is not improved with a single agent. In this study, we evaluated the effect of combined infusion of neostigmine and metoclopramide on gastric passage in critically ill patients in the intensive care unit (ICU).
  
  
  METHODS
  This study is a randomized double-blind controlled trial in 90 patients between 20 and 60years of age who were under mechanical ventilation and had gastric residual volumes (GRVs) >120mL 3h after the last lavage. Patients were randomly assigned to one of the following three groups: intravenous neostigmine 2.5mg, intravenous metoclopramide 20mg, and combination of both agents at the mentioned doses. Gastric volume aspiration was first performed before starting the study and then at 3, 6, 9, and 12h after the infusion of study drugs was finished. Increase in gastric lavage was defined as an aspiration volume of >120mL.
  
  
  RESULTS
  In total, 86 cases in the three groups completed the treatment (all 90 patients included in the study were analysed according to an intention-to-treat approach). There was no significant difference detected at baseline in age, intubation duration, albumin, haemoglobin, haematocrit, total leucocytic count (WBC), Na, K, Mg, and sequential organ failure assessment score between the study groups. In the combination group, 96.7% of patients showed GRV improvement (GRV<120cc), whereas in the metoclopramide and neostigmine groups, 50% and 43.3% of the patients, respectively, showed improvement (p<0.001). The frequency of overall adverse effects in the metoclopramide, neostigmine, and combination groups were 3.3%, 16.7%, and 10%, respectively (p=0.28).
  
  
  CONCLUSIONS
  The present results suggested that combination therapy with metoclopramide and neostigmine decreases GRV in critically ill patients with a higher efficacy than monotherapies.
authors.affiliation: Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Afshin Gholipour
authors.initials: AG
authors.lastname: Baradari
authors.affiliation: Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Khajavi
authors.affiliation: Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Abolfazl
authors.initials: A
authors.lastname: Firouzian
authors.affiliation: Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Alipour
authors.affiliation: Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Hojatallah
authors.initials: H
authors.lastname: Daneshpour
authors.affiliation: Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. Electronic address: yunespanahi@yahoo.com.
authors.forename: Yunes
authors.initials: Y
authors.lastname: Panahi
authors.affiliation: Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Amirhossein
authors.initials: A
authors.lastname: Sahebkar
mesh_terms: D000328:Adult; D016638:Critical Illness / Q000628:therapy*; D065127:Dopamine D2 Receptor Antagonists / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005746:Gastric Emptying / Q000187:drug effects*; D006801:Humans; D007275:Injections, Intravenous; D007362:Intensive Care Units; D008297:Male; D008787:Metoclopramide / Q000008:administration & dosage*; D008875:Middle Aged; D009388:Neostigmine / Q000008:administration & dosage*; D010277:Parasympathomimetics / Q000008:administration & dosage; D013270:Stomach / Q000187:drug effects / Q000503:physiopathology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D065127:Dopamine D2 Receptor Antagonists; D010277:Parasympathomimetics; D009388:Neostigmine; D008787:Metoclopramide
keywords: Gastrointestinal motility; Intensive care; Metoclopramide; Neostigmine; Prokinetic