Naldemedine is associated with earlier defecation in critically ill patients with opioid-induced constipation: A retrospective, single-center cohort study

• Published in: PloS one 2024-01, Vol.19 (1), p.e0295952-e0295952
• Main Authors: Nishiyama, Seiya, Uchino, Shigehiko, Sasabuchi, Yusuke, Masuyama, Tomoyuki, Lefor, Alan Kawarai, Sanui, Masamitsu
• Format: Article
• Language: English
• Subjects: Analgesics, Opioid - therapeutic use; Analysis; Anesthesia; Antibiotics; Biology and Life Sciences; Care and treatment; Cohort analysis; Cohort Studies; Complications and side effects; Constipation; Constipation - chemically induced; Constipation - drug therapy; Critical care; Critical Illness; Critically ill; Defecation; Diagnosis; Diarrhea; Enteral nutrition; Fentanyl; Hospital patients; Humans; Intensive care; Laxatives; Mechanical ventilation; Medical research; Medicine and Health Sciences; Medicine, Experimental; Missing data; Morphine; Mortality; Naltrexone - adverse effects; Narcotic Antagonists - pharmacology; Narcotics; Nutrition; Opioid-Induced Constipation - drug therapy; Opioids; Ostomy; Patient admissions; Regression analysis; Retrospective Studies; Risk factors; Social Sciences; Statistical analysis; Time dependence; Ventilation; Ventilators
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0295952

There are few reports describing the association of naldemedine with defecation in critically ill patients with opioid-induced constipation. The purpose of this study was to determine whether naldemedine is associated with earlier defecation in critically ill patients with opioid-induced constipation. In this retrospective cohort study, patients admitted to the Intensive Care Unit (ICU) without defecation for 48 hours while receiving opioids were eligible for enrollment. The primary endpoint was the time of the first defecation within 96 hours after inclusion. Secondary endpoints included presence of diarrhea, duration of mechanical ventilation, ICU length of stay, ICU mortality, and in-hospital mortality. The Cox proportional hazard regression analysis with time-dependent covariates was used to evaluate the association naldemedine with earlier defecation. A total of 875 patients were enrolled and were divided into 63 patients treated with naldemedine and 812 patients not treated. Defecation was observed in 58.7% of the naldemedine group and 48.8% of the no-naldemedine group during the study (p = 0.150). The naldemedine group had statistically significantly prolonged duration of mechanical ventilation (8.7 days vs 5.5 days, p < 0.001) and ICU length of stay (11.8 days vs 9.2 days, p = 0.001) compared to the no-naldemedine group. However, the administration of naldemedine was significantly associated with earlier defecation [hazard ratio:2.53; 95% confidence interval: 1.71-3.75, p < 0.001]. The present study shows that naldemedine is associated with earlier defecation in critically ill patients with opioid-induced constipation.