naloxone and Pneumonia--Aspiration

Hemodialysis therapy has been used in the treatment of acute alcohol intoxication for many years, especially acute severe alcohol intoxication.. This study aimed to evaluate whether the combination of conventional treatment and naloxone with hemodialysis has advantages over conventional treatment and naloxone alone in patients with acute severe alcohol intoxication.. After searching 12 databases and 2 clinical trial centers. According to the established inclusion and exclusion criteria, the qualified literatures were screened. The outcome indicators were length of hospital stay, coma time, time of symptom disappearance, the overall complication rate, the incidence of pancreatitis, the incidence of aspiration pneumonia, the incidence of hepatic and renal dysfunction. Analysis was performed using Revman 5.3.. This meta-analysis included 13 studies, including 932 subjects. In the treatment of acute severe alcohol intoxication, the use of hemodialysis on the basis of conventional treatment and naloxone could reduce the length of hospital stay (WMD = -15.16, 95% CI: -17.45 to -12.86, p < 0.001) in hours and (WMD = -4.89, 95% CI: -5.53 to -4.25, p < 0.001) in days; coma time (WMD = -5.43, 95% CI: -6.43 to -4.43, p < 0.001); time of symptom disappearance (WMD = -3.92, 95% CI: -5.37 to -2.47, p < 0.001); the overall complication rate (RR = 0.39, 95% CI: 0.28-0.55, p < 0.001); the incidence of pancreatitis (RR = 0.14, 95% CI: 0.05-0.43, p = 0.0006); the incidence of aspiration pneumonia (RR = 0.15, 95% CI: 0.04-0.66, p = 0.01), and the incidence of hepatic and renal dysfunction (RR = 0.21, 95% CI: 0.06-0.72, p = 0.01).. It can be concluded that compared with the use of conventional treatment and naloxone alone, the use of hemodialysis on the basis of conventional treatment and naloxone for acute severe alcohol intoxication can reduce the length of hospital stay, coma time, time of symptom disappearance, and the incidence of some complications rate. Large scale, multicenter, and well-designed RCTs are needed in the future to prove our conclusions.

Topics: Alcoholic Intoxication; Coma; Humans; Kidney Diseases; Multicenter Studies as Topic; Naloxone; Pancreatitis; Pneumonia, Aspiration; Renal Dialysis

Topics: Amines; Amitriptyline; Beclomethasone; Drug-Related Side Effects and Adverse Reactions; Heroin; Humans; Hydantoins; Lung Diseases; Methadone; Naloxone; Oxazoles; Pneumonia, Aspiration; Respiratory Therapy; Sulfasalazine; Ventilators, Mechanical

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: Diazepam; Glucose; Hospitalization; Humans; Hyperglycemia; Methadone; Myelitis, Transverse; Myoglobinuria; Naloxone; Narcotics; New York City; Pneumonia, Aspiration; Propranolol; Pulmonary Edema; Respiration; Substance Withdrawal Syndrome; Substance-Related Disorders; Tetanus Toxoid

Topics: Adolescent; Atrial Fibrillation; Blood Gas Analysis; Blood Pressure; Female; Heroin; Humans; Hypoxia; Intubation, Intratracheal; Levallorphan; Male; Nalorphine; Naloxone; Pneumonia, Aspiration; Positive-Pressure Respiration; Pulmonary Edema; Pupil; Respiration; Substance-Related Disorders