Does metoclopramide reduce aspiration, pneumonia and hypoxia in acute stroke patients who are fed by nasogastric tubes

INTERVENTION: Patients were randomized to one of two groups: 1) The intervention group: colourless metoclopramide syrup 10 mg tds (three times a day) (08:00, 15:00, and 21:00) via the nasogastric tube for 3 weeks or until discontinuation of nasogastric feeding 2) The control group: normal saline 10 ml via nasogastric tube tds (three times a day) (08:00, 15:00, and 21:00) for 3 weeks or until discontinuation of nasogastric feeding CONDITION: Cerebrovascular disease (acute strokes) and Pneumonia ; Circulatory System PRIMARY OUTCOME: The number of diagnosed episodes of pneumonia (any); ; Patients were examined clinically daily for signs and symptoms of pneumonia. Also a daily review of patient?s case note was done. If there was a clinical suspicion of pneumonia haematological (White cell count ‐WBC) and biochemical (CRP) investigations and a chest radiograph was requested. Laboratory test results and chest radiographs were reviewed (on the same day of request) for the diagnosis of pneumonia.; The fulfilment all these criteria, namely, the presence of abnormal chest signs and symptoms on clinical examination, elevation of WBC and CRP levels and development of new infiltrates in chest radiograph were required to diagnose pneumonia. (British Thoracic Society recommendations for the diagnosis of pneumonia in a hospital) SECONDARY OUTCOME: 1. The number of episodes of witnessed aspiration ‐ Daily review of patient?s case notes and nurse?s observation charts was done to identify documented episodes of aspiration. This continued daily over 21 days from recruitment or until the NG tube was removed ?which ever was earlier; 2. The number of antibiotic days‐ Daily review of patient?s prescription charts to review of antibiotic prescriptions ‐ continued daily over 21 days from recruitment or until the NG tube was removed ?which ever was earlier; 3. The number of different antibiotics prescribed ? Daily review of patient?s prescription charts‐ continued over 21 days from recruitment or until the NG tube was removed ?which ever was earlier; 4. The highest white blood count ? Daily review of patients investigation results from hospital online patients laboratory results system and review of patient?s case‐note ‐ continued over 21 days from recruitment or until the NG tube was removed ?which ever was earlier; 5. The highest CRP level Daily review of patients? investigation results from hospital online patients? laboratory results section and case‐note review‐ continued over 21 days from recruitment or until the NG tube was removed ?which ever was earlier; 6. End of trial outcomes (Nasogastric tube was removed as swallowing improved, referred for a PEG tube insertion and nasogastric tube removed due to withdrawal of treatment/palliation or commencement of the Liverpool care pathway for the dying.) ? Daily patient case notes review, continued over 21 days from recruitment or until the NG tube was removed ?which ever was earlier; 7. The lowest oxygen saturation Daily review of patient?s case‐notes and nurses observation charts. Also, daily measurement of oxygen saturations (using a pulse oximeter) at 10 am for 10 minutes and recording the lowest oxygen saturation recorded during that time. Continued daily over 21 days from recruitment or until the NG tube was removed ?which ever was earlier INCLUSION CRITERIA: All adult patients admitted to the Acute Stroke Unit at University Hospital of North Staffordshire were considered for enrolment into the study if they required placement of a nasogastric tube for enteral feeding and if they could be recruited either before or within 48 hours of insertion of the nasogastric tube, no longer than a week had passed since the stroke.