Abstract
IntroductionThe 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.MethodsA 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.ResultsIn 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.ConclusionsProkinetic 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.Trial registrationChinese Clinical Trial Registry ChiCTR-TRC-12001956. Registered 21 February 2012.
Highlights
The use of prokinetic agents on post-pyloric placement of spiral nasojejunal tubes is controversial
Five patients were excluded: the condition deteriorated rapidly in one patient and he died before insertion; in the other four patients, consent was withdrawn before insertion
Of the 100 patients in the metoclopramide group, 95 patients received 20 mg metoclopramide according to the protocol and five patients with renal insufficiency received 10 mg metoclopramide
Summary
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. Guidelines recommend postpyloric feeding as the preferred nutritional support route in critically ill patients with intolerance to gastric feeding. Fluoroscopic and endoscopic methods are mainly used in feeding tube placement [10,11]. Fluoroscopic and endoscopic methods are reliable but costly, often requiring transfer of patients and delaying early initiation of post-pyloric feeding in patients with critical illness [12]. By-the-bedside nasojejunal tube placement is possible in more than 80% of patients [14]. Various bedside techniques, including air insufflation, pH assisted and spontaneous passage with or without motility agents, are available to facilitate transpyloric feeding tube passage [16]
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