naloxone and Cross-Infection

Opioid analgesia impairs gastrointestinal motility. Enteral administration of naloxone theoretically allows selective blocking of intestinal opioid receptors caused by extensive presystemic metabolism. Therefore, we studied the effect of enteral naloxone on the amount of gastric tube reflux, the frequency of pneumonia, and the time until first defecation in mechanically ventilated patients with fentanyl analgesia.. Prospective, randomized, double-blinded study.. University hospital intensive care unit.. Eighty-four mechanically ventilated, fentanyl-treated patients without gastrointestinal surgery or diseases.. Patients were assigned to receive 8 mg naloxone or placebo four times daily via a gastric tube during fentanyl administration.. Thirty-eight patients received naloxone and 43 placebo; three patients were excluded because of protocol violation. Median gastric tube reflux volume (54 vs. 129 mL, p =.03) and frequency of pneumonia (34% vs. 56%, p =.04) were significantly lower in the naloxone group. In both groups, time until first defecation, ventilation time, and length of intensive care unit stay did not differ. There was no difference in fentanyl requirements between the naloxone and the placebo group (7 vs. 6.5 microg/kg/hr, p =.15).. Our results provide evidence that the administration of enteral opioid antagonists in ventilated patients with opioid analgesia might be a simple-and possibly preventive-treatment of increased gastric tube reflux and reduces frequency of pneumonia.

Topics: Administration, Oral; Adult; Analgesics, Opioid; Critical Care; Cross Infection; Defecation; Double-Blind Method; Enteral Nutrition; Female; Fentanyl; Gastric Emptying; Gastrointestinal Motility; Humans; Infection Control; Intubation, Gastrointestinal; Male; Middle Aged; Naloxone; Narcotic Antagonists; Pneumonia, Aspiration; Prospective Studies; Respiration, Artificial

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Clinical Trials as Topic; Critical Care; Cross Infection; Disseminated Intravascular Coagulation; Hemodynamics; Heparin; Humans; Immunization, Passive; Infections; Naloxone; Sepsis; Shock, Septic

Intragastric enteral feeding intolerance, common in the intensive care setting, is attributed to many causes. Opioid antagonists such as naloxone may have a role in reversing the intolerance when it is associated with intravenous opioid infusions. A 38-year-old woman hospitalized for acute respiratory distress syndrome was supported with low tidal volume mechanical ventilation. She required lorazepam and morphine administered by continuous intravenous infusion to achieve ventilator synchrony and pain control. While receiving these therapies, the patient developed persistent intolerance to intragastric feeding. Intravenous metoclopramide and laxatives did not decrease gastric volume residuals, and insertion of a jejunal tube was deemed unsafe due to worsening of her respiratory status. Total parenteral nutrition was begun to meet her caloric needs, but she experienced repeated catheter-related bloodstream infections. Naloxone 2 mg by gastric tube every 8 hours for 8 days was started; the dosage then was increased to 4 mg every 8 hours. Tube feeding was restarted, which provided the patient with more than 90% of her daily caloric needs and allowed for discontinuation of parenteral nutrition. With this dosage of naloxone, tolerance to intragastric feeding was maintained until the patient's death due to refractory respiratory failure. Enterally administered naloxone is an effective, noninvasive means of reversing intolerance to intragastric feeding associated with opioids.

Topics: Adult; Catheters, Indwelling; Cross Infection; Drug Administration Schedule; Enteral Nutrition; Fatal Outcome; Female; Food Hypersensitivity; Gastric Emptying; Gastrointestinal Motility; Humans; Infusions, Intravenous; Intubation, Gastrointestinal; Lorazepam; Morphine; Naloxone; Narcotics; Pregnancy; Respiratory Distress Syndrome; Respiratory Insufficiency; Time Factors

Topics: Critical Care; Cross Infection; Hemodynamics; Humans; Infections; Internal Medicine; Multiple Organ Failure; Naloxone; Prognosis; Sepsis; Shock, Septic