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

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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.

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References

  1. 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):414–420

    Article  Google Scholar 

  2. 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):2335–2340

    Article  Google Scholar 

  3. 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):318–328

    Article  Google Scholar 

  4. 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):293–300

    Article  CAS  Google Scholar 

  5. 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–e241

    Article  Google Scholar 

  6. 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):1182–1185

    Article  Google Scholar 

  7. 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):2284–2291

    Article  Google Scholar 

  8. 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):238–248

    Article  Google Scholar 

  9. 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

    Google Scholar 

  10. 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):156–162

    Article  CAS  Google Scholar 

  11. Ladopoulos T, Giannaki M, Alexopoulou C, Proklou A, Pediaditis E, Kondili E (2018) Gastrointestinal dysmotility in critically ill patients. Ann Gastroenterol 31(3):273

    PubMed  PubMed Central  Google Scholar 

  12. Reddymasu SC, Soykan I, McCallum RW (2007) Domperidone: review of pharmacology and clinical applications in gastroenterology. Off J Am College Gastroenterol ACG. 102(9):2036–2045

    Article  CAS  Google Scholar 

  13. 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):187–190

    Article  CAS  Google Scholar 

  14. 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):1835–1844

    Article  Google Scholar 

  15. 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

    Google Scholar 

  16. Verma R (2019) Stroke-associated pneumonia: management issues. J Neurosci Rural Pract 10(03):472–473

    Article  Google Scholar 

  17. 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):142–144

    Article  Google Scholar 

  18. 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):454–460

    Article  CAS  Google Scholar 

  19. Wani P, McCallum RW, Bustamante-Bernal M (2015) Domperidone: everything a gastroenterologist needs to know. Pract Gastroenterol 39(6):16–39

    Google Scholar 

  20. 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):2412–2419

    Article  Google Scholar 

  21. 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):e0245317

    Article  CAS  Google Scholar 

  22. 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):1–12

    Article  Google Scholar 

  23. 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):e0249645

    Article  CAS  Google Scholar 

  24. 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):371–374

    Article  CAS  Google Scholar 

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Acknowledgements

We acknowledge the staff of neurology department in Bouali hospital of Qazvin medical university whose cooperation made this study possible.

Funding

The authors have no financial interests to disclose.

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Authors and Affiliations

  1. Department of Infectious Diseases, Clinical Research Development Unit, BouAliSina Hospital, Qazvin University of Medical Sciences, Qazvin, Iran

    Abbas Allami

  2. Resident of Infectious Disease, BouAliSina Hospital, Qazvin University of Medical Sciences, Qazvin, Iran

    Somaieh Kianimajd

  3. Resident of Neurology Disease, BouAliSina Hospital, Qazvin University of Medical Sciences, Qazvin, Iran

    Shirin Mavandadi

  4. Neuroscience Research Center and Neurology Department, Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran

    Sepideh Paybast

Authors
  1. Abbas Allami
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  2. Somaieh Kianimajd
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  3. Shirin Mavandadi
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  4. Sepideh Paybast
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Contributions

AA: design of the work; and the acquisition, analysis, interpretation of data for the work. SK: design of the work; and the acquisition, interpretation of data for the work. SM: analysis and interpretation of data for the work. SP: drafting the work and revising it critically for important intellectual content.

Corresponding author

Correspondence to Sepideh Paybast.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics

This was double-blinded, randomized placebo-controlled trial conducted at Bouali Hospital, Qazvin during 2019–2021. The study received approval from the ethics committee of Qazvin University (IR.QUMS.REC.1398.258). The trial was also registered at Iranian Registry of Clinical Trials as IRCT (IRCT20201001048896N1). In addition, patients who met the eligibility criteria fulfilled the written informed consent prior admission to the study.

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Allami, A., Kianimajd, S., Mavandadi, S. et al. Evaluation of domperidone efficacy to prevent aspiration pneumonia in patients with acute ischemic stroke: a randomized clinical trial. Acta Neurol Belg 122, 1337–1342 (2022). https://doi.org/10.1007/s13760-022-01925-0

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  • DOI: https://doi.org/10.1007/s13760-022-01925-0

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