Efficacy of prokinetics in preventing pneumonia in post-stroke patients with nasogastric tubes: a systematic review and meta-analysis of randomized controlled trials.

内容摘要

Post-stroke patients with nasogastric tubes are at higher risk of aspiration pneumonia. In such cases, prokinetics have been linked with improved gastric emptying and reduced reflux, even though their effectiveness is controversial. This research aims to assess the application of prokinetics for the prevention of post-stroke pneumonia. We searched the databases Cochrane, PubMed, Embase, Web of Science and Scopus for RCTs up to November 2024. The outcome of interest was incidence pneumonia, and we assessed bias using RoB 2 and ROBINS-1. Overall, 326 articles were screened and 3 RCTs, comprising 600 patients, were included. There were 291 patients in the intervention group and 309 in the control group. Risk ratio for pneumonia was 0.80 (95% CI: 0.50-1.27, P>0.05), which showed no significant reduction. High heterogeneity was observed (I2=87%, P<0.001). Thirty- and 90-day mortality was not significantly different (RR=0.93, 95% CI: 0.75-1.17, P=0.349, I2=5%). Functional independence (mRS) was marginally better in some cases but not of clinical significance, with high heterogeneity (I2=82.2%). Neurological improvement (NIHSS) had variable results, with no overall benefit that reached statistical significance (pooled effect size = -0.05, 95% CI: -0.62-0.51, P=0.057, I2=72.4%). The variation observed limits the confidence in these findings. Prokinetics have no relationship with pneumonia in patients with nasogastric tubes according to the existing evidence. More trials are needed since there are no established guidelines.