Effect of Two Different Doses of Neostigmine on the Gastric Residual Volume and Aspiration in Critically Ill Patients Under Enteral Feeding; A Comparative Controlled Randomized Trial

Abstract

Background: Delayed gastric emptying increases the risk of patient morbidity in the ICU. Intensive care researchers have exerted considerable effort to measure and regulate gastric residual volumes (GRV) in ventilator-operated patients. Objectives: This study examines a cross-sectional, double-blind clinical trial designed to assess the effect of the addition of neostigmine to metoclopramide GRV in ICU patients and the risk of aspiration in those patients. Methods: Participants were categorized into three groups: Group I (n = 41) and group II (n = 43) received neostigmine 1 mg and 2 mg, respectively, and a control group (group III, n = 40) received 10 mL of normal saline. All participants received an intravenous administration of 10 mg of metoclopramide. The GRV was measured every 3 hours before enteral feeding. Aspiration through nasogastric (NG) or orogastric (OG) tubes was done before the next due bolus of feeding. The study did not receive any external funding support. The possessed data was interpreted using the PASS program, which set the alpha error at 5% and the power at 80%. Results: There was a significant variation among the three groups regarding the GRV. Metoclopramide used alone, did not profoundly alter the GRV at various time intervals. However, the administration of neostigmine resulted in a significant reduction in GRV at 3 and 6 hours post-injection. The GRV increased six hours post-injection, indicating that the drug combination resulted in a short-term effect. We did not observe any significant link between GRV and aspiration incidence, which happened even with low-volume aspirations. We used immunoassay to determine pepsin in the collected tracheal aspirations. Conclusions: Combining neostigmine and metoclopramide can effectively reduce GRV in ICU patients receiving enteral nutrition.