Metoclopramide for preventing nosocomial pneumonia in patients fed via nasogastric tubes: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND OBJECTIVES Metoclopramide, a prokinetic agent, has been recommended to reduce incidence of pneumonia, but its efficacy is controversial. Thus, this systematic review aimed to evaluate the effectiveness of metoclopramide for pneumonia in patients fed via nasogastric tube. METHODS AND STUDY DESIGN Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and OVID were searched from their inception to March 31th 2015. Randomized controlled trials (RCTs) of metoclopramide against placebo in patients fed via nasogastric tube were identified. The Cochrane risk of bias assessment tool was used for quality assessment. RESULTS Four trials involving 694 patients fed via nasogastric tube were identified. Compared with placebo, metoclopramide showed no significant effects in reducing pneumonia (n=694; risk ratio [RR]: 0.79; 95% CI: 0.45 to 1.38, p=0.40) or mortality (n=694; RR: 0.93; 95% CI: 0.78 to 1.11, p=0.44). In two trials using continuous data, metoclopramide significantly delayed the development of nosocomial pneumonia (n=80; weighted mean difference [WMD]: 1.74 days; 95% CI: 1.03 to 2.46 days, p<0.00001). However, in two other trials using dichotomous data, metoclopramide increased the proportion of cases showing early-onset nosocomial pneumonia (n=103; RR: 1.32; 95% CI: 1.10 to 1.58, p=0.003). Adverse effects monitoring was reported in one included trial, No significant adverse reactions were noted in this study. CONCLUSIONS Because of the poor methodological quality and high risk of bias in the included studies, this systematic review revealed no definite conclusion about the application of metoclopramide for the reduction of nosocomial pneumonia. Therefore, more high-quality studies with larger sample sizes are required.