Metoclopramida para migração do catéter do estômago para o duodeno: revisão sistemática com metanálises de ensaios clínicos randômicos
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Data
2006
Autores
Silva, Cristiane Costa Reis da [UNIFESP]
Orientadores
Atallah, Álvaro Nagib [UNIFESP]
Tipo
Tese de doutorado
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Introdução: A falta de nutrição adequada para atender às exigências metabólicas é reconhecida como motivo de preocupação séria nos pacientes clínicos e cirúrgicos. Se a ingestão oral de alimento não é suficiente, a nutrição enteral por cateter é a segunda opção. Para que o posicionamento do cateter no intestino seja mais rápido, pode-se lançar mão de manobras simples, como deitar o paciente em decúbito lateral direito, estimular a deambulação ou administrar um estimulante da motilidade gástrica. A droga mais comumente usada é a metoclopramida. Objetivos: Avaliar se a metoclopramida é eficaz e segura para auxiliar o procedimento de alocação do cateter em adultos;
determinar o momento e a dosagem da droga na passagem do cateter, além de verificar se a passagem do cateter no paciente em decúbito lateral direito facilita mais a migração do que em outras posições. Métodos: Revisão sistemática de ensaios clínicos randômicos, avaliando a metoclopramida na passagem do cateter do estômago
para o duodeno. Estudos relevantes foram identificados eletronicamente por meio de bases de dados MEDLINE, EMBASE, LILACS, Cochrane Controlled Trials register. Referências bibliográficas de artigos e outras revisões também foram pesquisadas para encontrar estudos não indexados. A qualidade metodológica foi avaliada com a escala
de Jadad e as análises foram executadas de acordo com o método de intenção de tratar. Resultados: Foram obtidos quatro ensaios clínicos randômicos, comparando metoclopramida com placebo, com um total de 204 participantes. Destes, 108 receberam metoclopramida e 96 receberam placebo. A administração de metoclopramida não se associou à melhor taxa de migração transpilórica em relação
ao grupo placebo (RR 0,83; IC 95% 0,61-1,13). Não houve diferença na freqüência de efeitos colaterais entre as intervenções. Não há dados relevantes avaliando posição e dose da medicação. Conclusões: Esta revisão, que inclui quatro estudos pequenos, não mostra evidências favoráveis à eficácia e segurança do uso de metoclopramida para facilitar a migração do cateter do estômago para o duodeno. Não estabeleceu também a efetividade do posicionamento do paciente para favorecer a migração do cateter do estômago para o duodeno, bem como para determinar o momento ideal e a dosagem eficaz na passagem do cateter.
Objectives: The lack of a correct nutrition to cope with the metabolic needs is highly recognized as a serious concern of clinic and surgical patients. If oral nourishment is not enough, the nourishment through enteral catheter would be the second option. Postpyloric catheter placement will be faster making some easy manoeuvres such as to put the patient in right handed lateral position, or stimulate deambulation. The stimulating gastric motility, drug such as metoclopramide is used as auxiliary therapy for catheter placement. The objetive of this review is to evaluate the effectiveness and safety of parenteral metoclopramide when administered in the post-pyloric placement in adult patients and to determine if metoclopramide could increase the success rate of transpyloric migration of naso-enteral catheter. Methods: Relevant RCTs were identified by eletronic searching of MEDLINE, EMBASE, LILACS, SCISEARCH, the Cochrane Trials Register.The bibliographic references identified were RCTs, textbooks; Review articles and metaanalyses were checked in order to find RCTs not identified by the eletronic searches.All the RCTs comparing Metoclopramide to placebo or no intervention in the gastrointestinal intubation of catheter were be included.RCTs will included irrespective of publication status,language ou blinding.The evaluation of methodological quality of the included studies were not assessed in a blind way and the Jadad scale was used.All the analysis were performed according to the intention-to-treat method. Results. Four clinical trials have been obtained (10,9,30,31) enrolling a total of 204 participants. Of them, 108 have been treated with metoclopramide, and 96 received placebo. Participants designated to undergo treatment with metoclopramide, compared with those allocated to receive placebo, presented: RR 0,83 (IC 95% 0,61 – 1,13). Conclusion. In this systematic review with metanalysis it was not possible to determine either superiority of one therapy or equivalence among the treatments to evaluate both effectiveness and safety of metoclopramide , compared with placebo, both of them administered by intravenous means.
Objectives: The lack of a correct nutrition to cope with the metabolic needs is highly recognized as a serious concern of clinic and surgical patients. If oral nourishment is not enough, the nourishment through enteral catheter would be the second option. Postpyloric catheter placement will be faster making some easy manoeuvres such as to put the patient in right handed lateral position, or stimulate deambulation. The stimulating gastric motility, drug such as metoclopramide is used as auxiliary therapy for catheter placement. The objetive of this review is to evaluate the effectiveness and safety of parenteral metoclopramide when administered in the post-pyloric placement in adult patients and to determine if metoclopramide could increase the success rate of transpyloric migration of naso-enteral catheter. Methods: Relevant RCTs were identified by eletronic searching of MEDLINE, EMBASE, LILACS, SCISEARCH, the Cochrane Trials Register.The bibliographic references identified were RCTs, textbooks; Review articles and metaanalyses were checked in order to find RCTs not identified by the eletronic searches.All the RCTs comparing Metoclopramide to placebo or no intervention in the gastrointestinal intubation of catheter were be included.RCTs will included irrespective of publication status,language ou blinding.The evaluation of methodological quality of the included studies were not assessed in a blind way and the Jadad scale was used.All the analysis were performed according to the intention-to-treat method. Results. Four clinical trials have been obtained (10,9,30,31) enrolling a total of 204 participants. Of them, 108 have been treated with metoclopramide, and 96 received placebo. Participants designated to undergo treatment with metoclopramide, compared with those allocated to receive placebo, presented: RR 0,83 (IC 95% 0,61 – 1,13). Conclusion. In this systematic review with metanalysis it was not possible to determine either superiority of one therapy or equivalence among the treatments to evaluate both effectiveness and safety of metoclopramide , compared with placebo, both of them administered by intravenous means.
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Citação
SILVA, Cristiane Costa Reis da. Metoclopramida para migração do catéter do estômago para o duodeno: revisão sistemática com metanálises de ensaios clínicos randômicos. 2006. 84 f. Tese (Doutorado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2007.