Metoclopramide vs Placebo for Prevention of Pneumonia in Acute Stroke
- Conditions
- Aspiration PneumoniaAcute Stroke
- Interventions
- Drug: Placebo
- Registration Number
- NCT04873297
- Lead Sponsor
- Shaheed Zulfiqar Ali Bhutto Medical University
- Brief Summary
Pneumonia is a major cause of mortality and morbidity in patients with acute stroke fed via nasogastric tubes and may be because of vomiting and gastro-esophageal regurgitation. The aim of the study was to assess whether regular treatment with metoclopramide, a D2-receptor antagonist with antiemetic and gastric prokinetic actions, could reduce the rate of pneumonia.
- Detailed Description
Patients admitted with no signs of pneumonia within 7 days of stroke onset and 48 hours of insertion of a nasogastric tube will be recruited into a single-blind randomized placebo-controlled study who will admit in Neurology Department, PIMS. Participants will receive metoclopramide 10 mg or placebo 3 times daily via the nasogastric tube for 4 days. Clinical signs of pneumonia will be recorded on alternate days. Pneumonia will be diagnosed if the patient has relevant clinical signs, high inflammatory markers, and new infiltrates on the chest radiograph. A sample size of 106 patients is calculated, 53 patients in each group. Non-probability consecutive sampling will be used for recruitment of participants. Study duration will be six months.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 106
- Patients of either gender.
- Patients within 7 days of acute ischemic or hemorrhagic stroke confirmed by computed tomographic scan of the brain who required nasogastric feeds for >24 hours, and could be recruited within 48 hours of NGT insertion
- Age above 13 years.
- Patients with aspiration pneumonia at the time of presentation.
- Patients with a history of chronic neurodegenerative diseases that could affect swallowing (e.g. Parkinson disease and motor neuron disease)
- Poor postural control (unable to sit up for swallowing assessment).
- Esophageal disorders,
- Contraindications to metoclopramide.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Placebo Group Placebo This group will be given placebo (normal saline 10ml via NG TDS) Metoclopramide Group Metoclopramide 10mg One group will be given metoclopramide 10mg TDS
- Primary Outcome Measures
Name Time Method Number of episodes of aspiration pneumonia 7 days Number of episodes of aspiration pneumonia will be observed after treatment with metoclopramide.
- Secondary Outcome Measures
Name Time Method Number of participants with swallowing improved +NGT removed 7 days During admission patient's swallowing with improved and NG tube removed.
Number of participants with treatment withdrawn and NGT removed 7 days Patient's swallowing with improved and treatment withdrawn and NG tube removed.
New onset of Fever 7 days Aspiraton pneumonia will be assess in terms of fever (\>98.6F)
Leukocytosis 7 days Aspiration pneumonia will be assess in terms of leukocytosis on blood counts \[ TLC \>12000/uL\]
Aspiration Pneumonia 7 days Treatment with metoclopramide in patients with acute stroke is hypothesized to prevent aspiration pneumonia and pneumonia will be assess in terms of new findings on chest x-ray of patients \[The posterior segment of the upper lobes and the superior segment of the lower lobes are most commonly involved lung sites when aspiration occurs in a recumbent patient. In an erect patient, aspiration is more likely to involve bilateral basal segments, middle lobe, and lingula- new exudate, new pleural effusion and new infiltrates\]
Trial Locations
- Locations (1)
Shaheed Zulfiqar Ali Bhutto Medical University
🇵🇰Islamabad, Pakistan