Majid Vatankhah, Saeed Kashani, Mohsen Sarafikhah, Bibi Mona Razavi, Mehrdad Sayadinia, Mehrdad Malekshoar,
Volume 83, Issue 2 (5-2025)
Abstract
Background: Aspiration pneumonia is a significant and potentially preventable cause of morbidity and mortality in critically ill ICU patients. Prophylactic pharmacological interventions, particularly antiemetics like metoclopramide (a prokinetic agent) and ondansetron (a 5-HT3 receptor antagonist), are commonly employed to reduce gastric aspiration and subsequent pneumonia. Despite their widespread use, comparative efficacy data remains limited. This randomized controlled trial was specifically designed to rigorously compare the effectiveness of these two distinct antiemetic strategies in preventing aspiration pneumonia among high-risk, mechanically ventilated patients, aiming to provide evidence-based guidance for clinical practice.
Methods: This double-blind randomized clinical trial involved 116 individuals admitted to the ICU at Shahid Mohammadi Hospital, Bandar Abbas from March 2024 to March 2025. Subjects were randomly assigned to metoclopramide or ondansetron groups. Enrollment criteria consisted of patients between 17 and 70 years old in the ICU requiring intubation and mechanical ventilation. Monitoring continued for 72 hours, with evaluation utilizing the Clinical Pulmonary Infection Score (CPIS), chest X-ray (CXR) results, and physical assessments. Data were analyzed with SPSS version 21 employing descriptive statistics (mean, standard deviation, percentage, frequency) and inferential tests with significance set at P<0.05.
Results: Chi-square analysis indicated no statistically significant gender difference between groups (P=0.947). Mean age was 30.6±10.5 years for metoclopramide recipients and 32.9±6.12 years for ondansetron recipients. Further analysis revealed no significant differences in age or BMI between cohorts. No significant difference emerged between metoclopramide and ondansetron groups regarding aspiration pneumonia occurrence, with similar incidence rates in both arms. Multiple logistic regression demonstrated that statistically, no variables influenced aspiration pneumonia development.
Conclusion: The results of this randomized trial clearly demonstrate no statistically significant difference in efficacy between metoclopramide and ondansetron for preventing aspiration pneumonia in intubated ICU patients. Both agents showed comparable effectiveness in our study population, suggesting that either drug represents a clinically acceptable prophylactic option. This finding provides clinicians with valuable therapeutic flexibility based on individual patient characteristics, drug availability, and cost considerations. However, further multicenter studies with larger sample sizes are recommended to confirm these findings across diverse patient populations and settings.
