Anaya AAJ, Zaragoza JJ, Monera MF, Monzón LJR, Fernández MJP, Negrete GG

Language: Spanish
References: 20
Page: 93-98
PDF size: 717.66 Kb.

ABSTRACT

Introduction: gastrointestinal motility disorders are common in the ICU (Intensive Care Unit) (ileus/pseudo-obstruction). Autonomic imbalance supports enhancing cholinergic transmission; neostigmine shows high effectiveness and safety, with bolus dosing yielding faster responses than infusions and reducing gastric residual compared with antiemetic/prokinetic alternatives. Uncertainty remains about its prokinetic role in a heterogeneous ICU population. We evaluated its effectiveness and safety. Material and methods: retrospective cohort in a tertiary ICU. Adults > 16 years, length of stay > 24 h, admissions 01/01/2023-07/31/2025. Ileus was pragmatically defined by use of ≥ 1 prokinetic; mechanical obstruction was excluded. Comparison: other prokinetics (metoclopramide, erythromycin, trimebutine, prucalopride) vs neostigmine (≥ 1 dose, alone or combined). Results: of 526 patients, 256 met criteria: 204 (79.7%) in control and 52 (20.3%) with neostigmine. No difference in time to first bowel movement (log-rank p = 0.137). In the adjusted model, neostigmine was not associated with the outcome: HR 0.80 (95%CI 0.55-1.17; p = 0.257). Conclusions: neostigmine may be used as rescue after failure of conservative measures when a rapid response is desired. Continuous monitoring and atropine availability are required due to bradycardia risk. Choose bolus vs infusion according to goals and comorbidities, within a multimodal approach (deprescribe ileus-promoting drugs, correct electrolytes, early mobilization). Prospective studies are needed to define indications, dosing, and patient selection.

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