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

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 constipatio...

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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
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Uchino, Shigehiko
Sasabuchi, Yusuke
Masuyama, Tomoyuki
Lefor, Alan Kawarai
Sanui, Masamitsu
description 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.
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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 &lt; 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 &lt; 0.001]. 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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 &lt; 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 &lt; 0.001]. The present study shows that naldemedine is associated with earlier defecation in critically ill patients with opioid-induced constipation.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>38170714</pmid><doi>10.1371/journal.pone.0295952</doi><tpages>e0295952</tpages><orcidid>https://orcid.org/0000-0003-2148-5556</orcidid><orcidid>https://orcid.org/0000-0001-6673-5630</orcidid><orcidid>https://orcid.org/0000-0002-0184-0381</orcidid><oa>free_for_read</oa></addata></record>
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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
title Naldemedine is associated with earlier defecation in critically ill patients with opioid-induced constipation: A retrospective, single-center cohort study
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