Opioids are a mainstay of care in the critical care unit, but theiruse frequently causes constipation which can lead to adverse outcomes including delayed feeding andlater discharge from the ICU. Researchers from London, UK, andChicago, IL, have found that methylnaltrexone (MNTX), a peripheralopioid antagonist, may restore bowel function in critically illpatients. Their retrospective study appears in the March issue of Mayo Clinic Proceedings. "We found MNTX to be very effective in producing laxation whencompared with conventional laxatives in our critically illpatients. MNTX was well tolerated and did not demonstrate any signsof reversing the effects of centrally mediated analgesia orprecipitate withdrawal," says lead author Parind B. Patel, MBBS,FRCA, Critical Care Medicine, Hammersmith Hospital, London. MNTXwas developed at the University of Chicago by Dr. Jonathan Moss. Researchers reviewed 88 nonsurgical critical care patients in theirICU during a 10-week period. 15 of the patients suffered fromopioid induced constipation (OIC) within 72 hours of admission tothe ICU. 7 were managed with MNTX and 8 were managed withconventional therapy consisting of sodium picosulfate and glycerinsuppositories. The most striking result was the immediate effect of MNTX. Laxationoccurred within 24 hours in 6 of the 7 patients, compared with noneof the 8 patients in the conventional therapy group. MNTX wasineffective in one patient with a large intra-abdominal hematoma.When this patient was excluded from the analysis, the MNTX-treatedpatients laxated within 7.8 hours vs. 96.0 hours for patients whoreceived conventional treatment. "We observed a clinically significant improvement in feeding anddecreased gastric residual volumes in our patients with MNTXtreatment," notes Dr. Patel. "Although our study was too small todemonstrate statistical significance, the improvement in enteralfeeding suggests that further study is merited. The reduction inresidual volumes following MNTX was dramatic and facilitated earlytarget enteral feeding. There is a trend toward improved outcome,but our study was too small to document this statistically." The lack of suitable therapy has hampered study of bowel functionin the ICU. "Our findings demonstrate a potential role for MNTX inmanaging OIC in critically ill patients and suggest that a largercontrolled study in the ICU environment is merited," Dr. Patelconcludes. Additional References Citations. The e-commerce company in China offers quality products such as Surface Mounted Pool Lights Manufacturer , Fountain LED Lights, and more. For more , please visit LED Swimming Pool Lights today!
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