Anushka Warusevitane A, Dumin Karunatilake D, Julius Sim J, Frank Lally F, and Christine Roffe C. Safety and Effect of Metoclopramide to Prevent Pneumonia in Patients With Stroke Fed via Nasogastric Tubes Trial. Stroke. 2014
Warusevitane et al evaluate whether metoclopramide, given to stroke patients with NG-tubes can decrease the rate of aspiration pneumonia. Patients with no signs of pneumonia within 7 days of stroke onset and 48 hours of insertion of NGT were recruited into this double blinded randomized placebo controlled trial in the UK. A total of 196 patients were evaluated and ultimately 60 patients were recruited to this study. Reasons for exclusions included chest infections and recruitment to another trial. 30 participants received 10 mg metoclopramide and 30 participants recieved placebo three times daily via NGT for 21 days or until NG feeds were discontinued. Pneumonia was diagnosed if patient had relevant clinical signs, inflammatory markers and new infiltrates on chest radiograph. Results showed that there was significant decrease in episodes of pneumonia in the metoclopramide group (rate ratio = 5.24; p <0.001; 26 from the control and 8 in the metoclopramide group experienced pneumonia). Baseline NIHSS for patient groups were high, averaging about 19 and 18 in the metoclopramide vs. placebo group. There was no significant difference in mortality between the groups. Almost all patients (98%) were fed via NGT for at least one week, 31 patients (51%) for two weeks and 19 patients (31%) for three weeks.
This is the first RCT to show that metoclopramide improves rate of pneumonia in stoke patients with NG tube feeds. The assumption is that the mechanism of pneumonia in these patients is due to an aspiration event. Through increasing gastric motility and decreasing stagnation of gastric contents, one can decrease the risk of aspiration. Additionally, what is impressive is that there were no untoward effects of dyskinesia or tardive dyskinesia. The results and mechanism are convincing on first impression, although a larger study is needed to confirm this finding.