Neostigmine resolves critical illness-related colonic ileus in intensive care patients with multiple organ failure – a prospective, double-blind, placebo-controlled trial

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Abstract
Objective: Critical illness-related colonic ileus (CIRCI) is characterized by the non-passage of stools in critically ill patients as a result of the absence of prokinetic movements of the colon, while the upper gastrointestinal tract functions properly and mechanical ileus is absent. We investigated whether neostigmine resulted in defecation in patients with CIRCI. Design: Double-blinded, placebo-controlled prospective study. Setting: Eighteen-bed intensive care unit. Patients: Thirty ventilated patients with multiple organ failure with CIRCI for >3 days. Intervention: Continuous intravenous administration of neostigmine 0.4-0.8 mg/h over 24 h, or placebo. Measurements and results: Time to first defecation and adverse reactions were recorded. Thirty patients were randomized, 24 could be evaluated. The mean prestudy time was 5 days, mean APACHE II score on admission was 23.2, and mean MOF score on the day of the study was 6.4. Of the 13 patients receiving neostigmine, 11 passed stools, whereas none of the placebo-treated patients passed stools (P Conclusion: Continuous infusion of 0.4-0.8 mg/h of neostigmine promotes defecation in ICU patients with a colonic ileus without important adverse reactions.

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