Imperial College London

ProfessorStephenBrett

Faculty of MedicineDepartment of Surgery & Cancer

Professor of Critical Care
 
 
 
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Contact

 

+44 (0)20 3313 4521stephen.brett Website

 
 
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Location

 

Hammersmith House 570Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Patel:2020:10.1007/s00134-019-05913-6,
author = {Patel, PB and Brett, S and O'Callaghan, D and Anjum, A and Cross, M and Warwick, J and Gordon, AC},
doi = {10.1007/s00134-019-05913-6},
journal = {Intensive Care Medicine},
pages = {747--755},
title = {A randomized clinical trial of methylnaltrexone for the treatment of opioid induced constipation & gastrointestinal stasis in intensive care patients; results from the MOTION trial},
url = {http://dx.doi.org/10.1007/s00134-019-05913-6},
volume = {46},
year = {2020}
}

RIS format (EndNote, RefMan)

TY  - JOUR
AB - PurposeConstipation can be a significant problem in critically unwell patients, associated with detrimental outcomes. Opioids are thought to contribute to the mechanism of bowel dysfunction. We tested if methylnaltrexone, a pure peripheral mu-opioid receptor antagonist, could reverse opioid induced constipationMethodsThe MOTION trial is a multi-centre, double blind, randomised placebo controlled trial to investigate whether methylnaltrexone alleviatesopioid induced constipation (OIC) in critical care patients. Eligibility criteria included adult ICU patients who were mechanically ventilated, receiving opioids and were constipated (had not opened bowels for a minimum 48 hours) despite prior administration of regular laxatives as per local bowel management protocol. The primary outcome was time to significant rescue-free laxation. Secondary outcomes included gastric residual volume, tolerance of enteral feeds, requirement for rescue laxatives, requirement for prokinetics, average number of bowel movements per day,escalation of opioid dose due to antagonism/reversal of analgesia, incidence of ventilator-associated pneumonia, incidence of diarrhoea and Clostridium difficileinfection and finally 28 day, ICU and hospital mortality.ResultsA total of 84 patients were enrolled and randomized (41 to methylnaltrexone and 43 to placebo). The baseline demographic characteristics of the two groups were generally well balanced. There was no significant differencein time to rescue-free laxation between the groups (Hazard ratio 1.42, 95%CI 0.82-2.46, p=0.22). There were no significant differencesin the majority of secondary outcomes, particularly days 1-3. However, during days 4-28, there were fewer median number of bowel movements per day in the methylnaltrexone group, (p=0.01) and a greater incidence of diarrhoea in the placebo group (p=0.02). There was a marked difference in mortality between the groups, with ten deaths in the methylnaltrexone group and two in the placebo group
AU - Patel,PB
AU - Brett,S
AU - O'Callaghan,D
AU - Anjum,A
AU - Cross,M
AU - Warwick,J
AU - Gordon,AC
DO - 10.1007/s00134-019-05913-6
EP - 755
PY - 2020///
SN - 0342-4642
SP - 747
TI - A randomized clinical trial of methylnaltrexone for the treatment of opioid induced constipation & gastrointestinal stasis in intensive care patients; results from the MOTION trial
T2 - Intensive Care Medicine
UR - http://dx.doi.org/10.1007/s00134-019-05913-6
UR - https://link.springer.com/article/10.1007%2Fs00134-019-05913-6
UR - http://hdl.handle.net/10044/1/76582
VL - 46
ER -