Efficacy of prucalopride in critically ill patients with paralytic ileus; a pilot randomized double-blind placebo controlled trial.
J Gastroenterol Hepatol. 2020 Jun 01;:
Authors: Jandee S, Wetwittayakhlang P, Boonsri P
BACKGROUND: Paralytic ileus is a common intestinal dysfunction in critically ill patients, which results in complications and poor hospital outcomes. There are still no established effective medications, except correcting the primary causes and prokinetics trial, which have limited efficacy and potential adverse events.
AIMS: To evaluate the efficacy of prucalopride on paralytic ileus in critically ill patients.
METHODS: A randomized, double-blind, placebo-controlled trial of 5 consecutive days treatment periods was conducted. Critically ill patients with paralytic ileus were included. The primary endpoint was the improvement of bowel dilatation on plain abdominal radiography. The secondary endpoints were the change of abdominal circumference.
RESULTS: Twenty patients were consecutively enrolled in the study. There was no significant difference in baseline characteristics of patients. The common causes of hospitalization were infection and respiratory problems. The maximum large bowel diameters dramatically decreased in prucalopride group and reached maximum point on the 3rd day after intervention when compared with placebo [-2.1 (+1.8) vs. 0.3 (+1.5) cm, p = 0.01]. The maximum small bowel diameters were noticeably less decreased and were not significantly different when compared to placebo. The abdominal circumferences notably decreased and significantly diverged from placebo on the 3rd day.
CONCLUSIONS: Prucalopride was an effective enterokinetic agent to improve non-severe inflammatory or ischemic bowel conditions related paralytic ileus in critically ill patients. Its effect was predominant on large intestine, but could not be well demonstrated on small bowel in this study. Future study or concomitant other prokinetics for upper gut motility should be further evaluated.
PMID: 32483847 [PubMed - as supplied by publisher]