Randomized controlled trial: neostigmine for intra-abdominal hypertension in acute pancreatitis

He, Wenhua, Chen, Peng, Lei, Yupeng, Xia, Liang, Liu, Pi, Zhu, Yong, Zeng, Hao, Wu, Yao, Ke, Huajing, Huang, Xin
et al (show 6 more authors) (2022) Randomized controlled trial: neostigmine for intra-abdominal hypertension in acute pancreatitis. CRITICAL CARE, 26 (1). 52-.

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<h4>Background</h4>Intra-abdominal hypertension (IAH) in acute pancreatitis (AP) is associated with deterioration in organ function. This trial aimed to assess the efficacy of neostigmine for IAH in patients with AP.<h4>Methods</h4>In this single-center, randomized trial, consenting patients with IAH within 2 weeks of AP onset received conventional treatment for 24 h. Patients with sustained intra-abdominal pressure (IAP) ≥ 12 mmHg were randomized to receive intramuscular neostigmine (1 mg every 12 h increased to every 8 h or every 6 h, depending on response) or continue conventional treatment for 7 days. The primary outcome was the percent change of IAP at 24 h after randomization.<h4>Results</h4>A total of 80 patients were recruited to neostigmine (n = 40) or conventional treatment (n = 40). There was no significant difference in baseline parameters. The rate of decrease in IAP was significantly faster in the neostigmine group compared to the conventional group by 24 h (median with 25th-75th percentile: -18.7% [- 28.4 to - 4.7%] vs. - 5.4% [- 18.0% to 0], P = 0.017). This effect was more pronounced in patients with baseline IAP ≥ 15 mmHg (P = 0.018). Per-protocol analysis confirmed these results (P = 0.03). Stool volume was consistently higher in the neostigmine group during the 7-day observational period (all P < 0.05). Other secondary outcomes were not significantly different between neostigmine and conventional treatment groups.<h4>Conclusion</h4>Neostigmine reduced IAP and promoted defecation in patients with AP and IAH. These results warrant a larger, placebo-controlled, double-blind phase III trial. Trial registration Clinical Trial No: NCT02543658 (registered August /27, 2015).

Item Type: Article
Uncontrolled Keywords: Neostigmine, Acute pancreatitis, Intra-abdominal hypertension, Acute compartment syndrome
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User: Symplectic Admin
Date Deposited: 25 Apr 2022 07:30
Last Modified: 18 Jan 2023 21:04
DOI: 10.1186/s13054-022-03922-4
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3153802