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Published in: Acta Neurologica Belgica 5/2022

14-04-2022 | Stroke | Evidence- and experienced-based Neurology article

Evaluation of domperidone efficacy to prevent aspiration pneumonia in patients with acute ischemic stroke: a randomized clinical trial

Authors: Abbas Allami, Somaieh Kianimajd, Shirin Mavandadi, Sepideh Paybast

Published in: Acta Neurologica Belgica | Issue 5/2022

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Abstract

Background and aim

Aspiration pneumonia is an essential complication of acute ischemic stroke (AIS), which is responsible for increased three-fold mortality within a month. There is an interest towards the effect of prokinetics on prevention of stroke-associated pneumonia. The present study aimed to investigate the effect of domperidone to prevent pneumonia in patients with AIS.

Methods

In this randomized clinical trial, 150 patients with AIS were assigned to receive either domperidone 10 mg daily or placebo during hospitalization. The clinical outcomes including of aspiration pneumonia occurrence, gastrointestinal discomfort, the need for intensive care unit admission, the length of hospitalization, final mRs, and mortality were then evaluated in both groups.

Results

150 [Mean age 67.5 ± 13.5 years, 90 men and 60 women] were randomized in a 1:1 ratio. Both groups were similar in terms of baseline characteristics. The domperidone group experienced significantly less dysphagia, nausea and vomiting, and aspiration pneumonia (P < 0.005). Although domperidone did not considerably reduce the mortality (P = 0.978), it resulted in lower mean mRS and shorter length of hospitalization (P < 0.001).

Conclusion

Domperidone is an effective and well tolerated agent which could be considered as a promising agent to prevent stroke-associated pneumonia leading to a better clinical recovery.
Literature
1.
go back to reference Indredavik B, Rohweder G, Naalsund E, Lydersen S (2008) Medical complications in a comprehensive stroke unit and an early supported discharge service. Stroke 39(2):414–420CrossRef Indredavik B, Rohweder G, Naalsund E, Lydersen S (2008) Medical complications in a comprehensive stroke unit and an early supported discharge service. Stroke 39(2):414–420CrossRef
2.
go back to reference Smith CJ, Kishore AK, Vail A, Chamorro A, Garau J, Hopkins SJ et al (2015) Diagnosis of stroke-associated pneumonia: recommendations from the pneumonia in stroke consensus group. Stroke 46(8):2335–2340CrossRef Smith CJ, Kishore AK, Vail A, Chamorro A, Garau J, Hopkins SJ et al (2015) Diagnosis of stroke-associated pneumonia: recommendations from the pneumonia in stroke consensus group. Stroke 46(8):2335–2340CrossRef
3.
go back to reference Kishore AK, Jeans AR, Garau J, Bustamante A, Kalra L, Langhorne P et al (2019) Antibiotic treatment for pneumonia complicating stroke: recommendations from the pneumonia in stroke consensus (PISCES) group. Eur Stroke J 4(4):318–328CrossRef Kishore AK, Jeans AR, Garau J, Bustamante A, Kalra L, Langhorne P et al (2019) Antibiotic treatment for pneumonia complicating stroke: recommendations from the pneumonia in stroke consensus (PISCES) group. Eur Stroke J 4(4):318–328CrossRef
4.
go back to reference Teh W-H, Smith CJ, Barlas RS, Wood AD, Bettencourt-Silva JH, Clark AB et al (2018) Impact of stroke-associated pneumonia on mortality, length of hospitalization, and functional outcome. Acta Neurol Scand 138(4):293–300CrossRef Teh W-H, Smith CJ, Barlas RS, Wood AD, Bettencourt-Silva JH, Clark AB et al (2018) Impact of stroke-associated pneumonia on mortality, length of hospitalization, and functional outcome. Acta Neurol Scand 138(4):293–300CrossRef
5.
go back to reference Schwarz M, Coccetti A, Murdoch A, Cardell E (2018) The impact of aspiration pneumonia and nasogastric feeding on clinical outcomes in stroke patients: a retrospective cohort study. J Clin Nurs 27(1–2):e235–e241CrossRef Schwarz M, Coccetti A, Murdoch A, Cardell E (2018) The impact of aspiration pneumonia and nasogastric feeding on clinical outcomes in stroke patients: a retrospective cohort study. J Clin Nurs 27(1–2):e235–e241CrossRef
6.
go back to reference Chang C-Y, Cheng T-J, Lin C-Y, Chen J-Y, Lu T-H, Kawachi I (2013) Reporting of aspiration pneumonia or choking as a cause of death in patients who died with stroke. Stroke 44(4):1182–1185CrossRef Chang C-Y, Cheng T-J, Lin C-Y, Chen J-Y, Lu T-H, Kawachi I (2013) Reporting of aspiration pneumonia or choking as a cause of death in patients who died with stroke. Stroke 44(4):1182–1185CrossRef
7.
go back to reference Sellars C, Bowie L, Bagg J, Sweeney MP, Miller H, Tilston J et al (2007) Risk factors for chest infection in acute stroke: a prospective cohort study. Stroke 38(8):2284–2291CrossRef Sellars C, Bowie L, Bagg J, Sweeney MP, Miller H, Tilston J et al (2007) Risk factors for chest infection in acute stroke: a prospective cohort study. Stroke 38(8):2284–2291CrossRef
8.
go back to reference Flowers HL, Silver FL, Fang J, Rochon E, Martino R (2013) The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke. J Commun Disord 46(3):238–248CrossRef Flowers HL, Silver FL, Fang J, Rochon E, Martino R (2013) The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke. J Commun Disord 46(3):238–248CrossRef
9.
go back to reference Murat Arsava E, Aydoğdu İ, Güngör L, TogayIşıkay C, Yaka E (2018) Nutritional approach and treatment in patients with stroke, an expert opinion for Turkey. Turk J Neurol/Turk Noroloji Dergisi 24(3):226–242 Murat Arsava E, Aydoğdu İ, Güngör L, TogayIşıkay C, Yaka E (2018) Nutritional approach and treatment in patients with stroke, an expert opinion for Turkey. Turk J Neurol/Turk Noroloji Dergisi 24(3):226–242
10.
go back to reference Mahmoodpoor A, Hamishehkar H, Asghari R, Abri R, Shadvar K, Sanaie S (2019) Effect of a probiotic preparation on ventilator-associated pneumonia in critically ill patients admitted to the intensive care unit: a prospective double-blind randomized controlled trial. Nutr Clin Pract 34(1):156–162CrossRef Mahmoodpoor A, Hamishehkar H, Asghari R, Abri R, Shadvar K, Sanaie S (2019) Effect of a probiotic preparation on ventilator-associated pneumonia in critically ill patients admitted to the intensive care unit: a prospective double-blind randomized controlled trial. Nutr Clin Pract 34(1):156–162CrossRef
11.
go back to reference Ladopoulos T, Giannaki M, Alexopoulou C, Proklou A, Pediaditis E, Kondili E (2018) Gastrointestinal dysmotility in critically ill patients. Ann Gastroenterol 31(3):273PubMedPubMedCentral Ladopoulos T, Giannaki M, Alexopoulou C, Proklou A, Pediaditis E, Kondili E (2018) Gastrointestinal dysmotility in critically ill patients. Ann Gastroenterol 31(3):273PubMedPubMedCentral
12.
go back to reference Reddymasu SC, Soykan I, McCallum RW (2007) Domperidone: review of pharmacology and clinical applications in gastroenterology. Off J Am College Gastroenterol ACG. 102(9):2036–2045CrossRef Reddymasu SC, Soykan I, McCallum RW (2007) Domperidone: review of pharmacology and clinical applications in gastroenterology. Off J Am College Gastroenterol ACG. 102(9):2036–2045CrossRef
13.
go back to reference Ott DJ, Hodge RG, Pikna LA, Chen MY, Gelfand DW (1996) Modified barium swallow: clinical and radiographic correlation and relation to feeding recommendations. Dysphagia 11(3):187–190CrossRef Ott DJ, Hodge RG, Pikna LA, Chen MY, Gelfand DW (1996) Modified barium swallow: clinical and radiographic correlation and relation to feeding recommendations. Dysphagia 11(3):187–190CrossRef
14.
go back to reference Kalra L, Irshad S, Hodsoll J, Simpson M, Gulliford M, Smithard D et al (2015) Prophylactic antibiotics after acute stroke for reducing pneumonia in patients with dysphagia (STROKE-INF): a prospective, cluster-randomised, open-label, masked endpoint, controlled clinical trial. Lancet 386(10006):1835–1844CrossRef Kalra L, Irshad S, Hodsoll J, Simpson M, Gulliford M, Smithard D et al (2015) Prophylactic antibiotics after acute stroke for reducing pneumonia in patients with dysphagia (STROKE-INF): a prospective, cluster-randomised, open-label, masked endpoint, controlled clinical trial. Lancet 386(10006):1835–1844CrossRef
15.
go back to reference Wei H-Y, Wang L-F, Gu J-P (2009) Observation of the effect of domperidone on infants with pneumonia related with gastro esophageal reflux. J Pediatr Pharm. 1:18–20 Wei H-Y, Wang L-F, Gu J-P (2009) Observation of the effect of domperidone on infants with pneumonia related with gastro esophageal reflux. J Pediatr Pharm. 1:18–20
16.
go back to reference Verma R (2019) Stroke-associated pneumonia: management issues. J Neurosci Rural Pract 10(03):472–473CrossRef Verma R (2019) Stroke-associated pneumonia: management issues. J Neurosci Rural Pract 10(03):472–473CrossRef
17.
go back to reference He M, Ohrui T, Ebihara T, Ebihara S, Sasaki H, Arai H (2007) Mosapride citrate prolongs survival in stroke patients with gastrostomy. J Am Geriatr Soc 55(1):142–144CrossRef He M, Ohrui T, Ebihara T, Ebihara S, Sasaki H, Arai H (2007) Mosapride citrate prolongs survival in stroke patients with gastrostomy. J Am Geriatr Soc 55(1):142–144CrossRef
18.
go back to reference Warusevitane A, Karunatilake D, Sim J, Lally F, Roffe C (2015) Safety and effect of metoclopramide to prevent pneumonia in patients with stroke fed via nasogastric tubes trial. Stroke 46(2):454–460CrossRef Warusevitane A, Karunatilake D, Sim J, Lally F, Roffe C (2015) Safety and effect of metoclopramide to prevent pneumonia in patients with stroke fed via nasogastric tubes trial. Stroke 46(2):454–460CrossRef
19.
go back to reference Wani P, McCallum RW, Bustamante-Bernal M (2015) Domperidone: everything a gastroenterologist needs to know. Pract Gastroenterol 39(6):16–39 Wani P, McCallum RW, Bustamante-Bernal M (2015) Domperidone: everything a gastroenterologist needs to know. Pract Gastroenterol 39(6):16–39
20.
go back to reference Ren L-H, Chen W-X, Qian L-J, Li S, Gu M, Shi R-H (2014) Addition of prokinetics to PPI therapy in gastroesophageal reflux disease: a meta-analysis. World J Gastroenterol: WJG 20(9):2412–2419CrossRef Ren L-H, Chen W-X, Qian L-J, Li S, Gu M, Shi R-H (2014) Addition of prokinetics to PPI therapy in gastroesophageal reflux disease: a meta-analysis. World J Gastroenterol: WJG 20(9):2412–2419CrossRef
21.
go back to reference Peng R, Li H, Yang L, Zeng L, Yi Q, Xu P et al (2021) The efficacy and safety of prokinetics in critically ill adults receiving gastric feeding tubes: a systematic review and meta-analysis. PLoS ONE 16(1):e0245317CrossRef Peng R, Li H, Yang L, Zeng L, Yi Q, Xu P et al (2021) The efficacy and safety of prokinetics in critically ill adults receiving gastric feeding tubes: a systematic review and meta-analysis. PLoS ONE 16(1):e0245317CrossRef
22.
go back to reference Lewis K, Alqahtani Z, Mcintyre L, Almenawer S, Alshamsi F, Rhodes A et al (2016) The efficacy and safety of prokinetic agents in critically ill patients receiving enteral nutrition: a systematic review and meta-analysis of randomized trials. Crit Care 20(1):1–12CrossRef Lewis K, Alqahtani Z, Mcintyre L, Almenawer S, Alshamsi F, Rhodes A et al (2016) The efficacy and safety of prokinetic agents in critically ill patients receiving enteral nutrition: a systematic review and meta-analysis of randomized trials. Crit Care 20(1):1–12CrossRef
23.
go back to reference Huang K-S, Pan B-L, Lai W-A, Bin P-J, Yang Y-H, Chou C-P (2021) Could prokinetic agents protect long-term nasogastric tube-dependent patients from being hospitalized for pneumonia? A nationwide population-based case-crossover study. PLoS ONE 16(4):e0249645CrossRef Huang K-S, Pan B-L, Lai W-A, Bin P-J, Yang Y-H, Chou C-P (2021) Could prokinetic agents protect long-term nasogastric tube-dependent patients from being hospitalized for pneumonia? A nationwide population-based case-crossover study. PLoS ONE 16(4):e0249645CrossRef
24.
go back to reference Nassaji M, Ghorbani R, Frozeshfard M, Mesbahian F (2010) Effect of metoclopramide on nosocomial pneumonia in patients with nasogastric feeding in the intensive care unit. Eastern Mediterr Health J (EMHJ) 16(4):371–374CrossRef Nassaji M, Ghorbani R, Frozeshfard M, Mesbahian F (2010) Effect of metoclopramide on nosocomial pneumonia in patients with nasogastric feeding in the intensive care unit. Eastern Mediterr Health J (EMHJ) 16(4):371–374CrossRef
Metadata
Title
Evaluation of domperidone efficacy to prevent aspiration pneumonia in patients with acute ischemic stroke: a randomized clinical trial
Authors
Abbas Allami
Somaieh Kianimajd
Shirin Mavandadi
Sepideh Paybast
Publication date
14-04-2022
Publisher
Springer International Publishing
Published in
Acta Neurologica Belgica / Issue 5/2022
Print ISSN: 0300-9009
Electronic ISSN: 2240-2993
DOI
https://doi.org/10.1007/s13760-022-01925-0

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