Neostigmine resolves critical illness-related colonic ileus in intensive care patients with multiple organ failure--a prospective, double-blind, placebo-controlled trial - PubMed (original) (raw)

Clinical Trial

Neostigmine resolves critical illness-related colonic ileus in intensive care patients with multiple organ failure--a prospective, double-blind, placebo-controlled trial

J I van der Spoel et al. Intensive Care Med. 2001 May.

Abstract

Objective: Critical illness-related colonic ileus (CIRCI) is characterized by the non-passage of stools in critically ill patients as a result of the absence of prokinetic movements of the colon, while the upper gastrointestinal tract functions properly and mechanical ileus is absent: We investigated whether neostigmine resulted in defecation in patients with CIRCI.

Design: Double-blinded, placebo-controlled prospective study.

Setting: Eighteen-bed intensive care unit.

Patients: Thirty ventilated patients with multiple organ failure with CIRCI for > 3 days.

Intervention: Continuous intravenous administration of neostigmine 0.4-0.8 mg/h over 24 h, or placebo.

Measurements and results: Time to first defecation and adverse reactions were recorded. Thirty patients were randomized, 24 could be evaluated. The mean prestudy time was 5 days, mean APACHE II score on admission was 23.2, and mean MOF score on the day of the study was 6.4. Of the 13 patients receiving neostigmine, 11 passed stools, whereas none of the placebo-treated patients passed stools (P < 0.001). After 24 h, the non-responders received in a cross-over fashion neostigmine or placebo respectively. Eight out of the 11 neostigmine patients now passed stools (mean 11.4 h), and none of the placebo patients. Overall, in none of the patients did passage of stools occur during placebo infusion, whereas 19 of the 24 neostigmine-treated patients had defecation (79%). No acute serious adverse effects occurred, but three patients had ischemic colonic complications 7-10 days after treatment.

Conclusion: Continuous infusion of 0.4-0.8 mg/h of neostigmine promotes defecation in ICU patients with a colonic ileus without important adverse reactions.

PubMed Disclaimer

Similar articles

• Neostigmine infusion: new standard of care for acute colonic pseudo-obstruction?
  Amaro R, Rogers AI. Amaro R, et al. Am J Gastroenterol. 2000 Jan;95(1):304-5. doi: 10.1111/j.1572-0241.2000.01737.x. Am J Gastroenterol. 2000. PMID: 10638606 Clinical Trial.
• Laxation of critically ill patients with lactulose or polyethylene glycol: a two-center randomized, double-blind, placebo-controlled trial.
  van der Spoel JI, Oudemans-van Straaten HM, Kuiper MA, van Roon EN, Zandstra DF, van der Voort PH. van der Spoel JI, et al. Crit Care Med. 2007 Dec;35(12):2726-31. doi: 10.1097/01.CCM.0000287526.08794.29. Crit Care Med. 2007. PMID: 17893628 Clinical Trial.
• Safety and Efficacy of Intermittent Bolus and Continuous Infusion Neostigmine for Acute Colonic Pseudo-Obstruction.
  Smedley LW, Foster DB, Barthol CA, Hall R, Gutierrez GC. Smedley LW, et al. J Intensive Care Med. 2020 Oct;35(10):1039-1043. doi: 10.1177/0885066618809010. Epub 2018 Oct 29. J Intensive Care Med. 2020. PMID: 30373445
• Intravenous neostigmine for postoperative acute colonic pseudo-obstruction.
  Elsner JL, Smith JM, Ensor CR. Elsner JL, et al. Ann Pharmacother. 2012 Mar;46(3):430-5. doi: 10.1345/aph.1Q515. Epub 2012 Feb 28. Ann Pharmacother. 2012. PMID: 22388328 Review.
• Acute colonic pseudo-obstruction: rapid correction with neostigmine in the emergency department.
  McNamara R, Mihalakis MJ. McNamara R, et al. J Emerg Med. 2008 Aug;35(2):167-70. doi: 10.1016/j.jemermed.2007.06.043. Epub 2008 Feb 1. J Emerg Med. 2008. PMID: 18242923 Review.

Cited by

• Effect of sugammadex with neostigmine on postoperative bowel function and on recovery of neuromuscular functions: A randomized controlled trial.
  Postaci A, Durgut R, Aytac BG, Ceyhan M. Postaci A, et al. Medicine (Baltimore). 2024 Sep 13;103(37):e39623. doi: 10.1097/MD.0000000000039623. Medicine (Baltimore). 2024. PMID: 39287249 Free PMC article. Clinical Trial.
• Acute Colonic Pseudo-Obstruction (Ogilvie's Syndrome).
  Tack J. Tack J. Curr Treat Options Gastroenterol. 2006 Jul;9(4):361-8. doi: 10.1007/s11938-006-0018-3. Curr Treat Options Gastroenterol. 2006. PMID: 16836955
• Differential reversal of drug-induced small bowel paralysis by cerulein and neostigmine.
  Fruhwald S, Herk E, Hammer HF, Holzer P, Metzler H. Fruhwald S, et al. Intensive Care Med. 2004 Jul;30(7):1414-20. doi: 10.1007/s00134-004-2317-2. Epub 2004 May 18. Intensive Care Med. 2004. PMID: 15148569
• Gastrointestinal motility in acute illness.
  Fruhwald S, Holzer P, Metzler H. Fruhwald S, et al. Wien Klin Wochenschr. 2008;120(1-2):6-17. doi: 10.1007/s00508-007-0920-2. Wien Klin Wochenschr. 2008. PMID: 18239985 Review.
• Acute colonic pseudo-obstruction: A systematic review of aetiology and mechanisms.
  Wells CI, O'Grady G, Bissett IP. Wells CI, et al. World J Gastroenterol. 2017 Aug 14;23(30):5634-5644. doi: 10.3748/wjg.v23.i30.5634. World J Gastroenterol. 2017. PMID: 28852322 Free PMC article.

Publication types

MeSH terms

Substances

LinkOut - more resources

• Full Text Sources

  • Springer