Neostigmine infusion versus syrup lactulose for the treatment of constipation in Intensive Care Unit (ICU) : a randomized, controlled study
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Date
2016-05
Authors
Suhaimi, Norlida
Journal Title
Journal ISSN
Volume Title
Publisher
Pusat Pengajian Sains Perubatan, Universiti Sains Malaysia
Abstract
Introduction
Constipation and its implications have received very little attention even though this
gastrointestinal motility disorders are common in critically ill patients. Constipation is
defined as failure of the bowel to open for 3 consecutive days. This condition can give rise
few adverse implications in critically ill patients such as more constipated patient failed to
wean from mechanical ventilation, the median length of stay in intensive care increase and
the proportion of enteral feeding intolerance were greater than non-constipated patients.
Objectives
To compare bowel opening between groups of patients who receive neostigmine infusion
versus syrup lactulose for treatment of constipation in ICU.
Methodology
This is a prospective study. The ventilated patients who fulfilled the inclusion criteria and
were admitted to HUSM ICU between February till October 2015 were randomly received
either neostigmine infusions 0.4 – 0.8 mg/hour or syrup lactulose 15 mls TDS. Incidence of
bowel opening, time to first bowel opening and any adverse reactions were recorded.
Results
40 patients were randomized where 20 patients in each group either neostigmine infusion or
syrup lactulose. Neostigmine infusion group significantly had bowel opening (pvalue=
0.027) and markedly had faster onset of bowel opening (p-value<0.001) compared to
syrup lactulose group. There was no significant mean different in term of length of
mechanical ventilation between two group of therapy (p-value=0.542). No complications
occurred from the neostigmine infusion.
Conclusion
Neostigmine infusion was effective for treatment of constipation in ICU compared than
standard therapy syrup lactulose. Continuous intravenous neostigmine infusion of up to 0.8
mg / hour to critically ill patients appears to be safe.
Description
Keywords
Constipation