IM neostigmine reduces IAP in patients with acute pancreatitis and intra-abdominal hypertension

China: Findings from a randomized controlled phase II clinical trial showed that in patients with acute pancreatitis (AP) and intra-abdominal hypertension (IAH), neostigmine reduces intra-abdominal pressure (IAP) and promotes defecation. The study appears in the BMC journal Critical Care. 

Acute pancreatitis is a common disease of the digestive system. Severe AP (SAP) with persistent organ failure is related to an increased death risk. According to the World Society for Abdominal Compartment Syndrome (WSACS), IAH is defined as a persistent increase in IAP  ≥ 12 mmHg. IAH is considered to be an early risk factor in SAP development. And, IAH in AP is associated with deterioration in organ function. 

Against the above background, Nonghua Lu, First Affiliated Hospital of Nanchang University, Nanchang, China, and colleagues aimed to assess the efficacy of neostigmine for IAH in patients with AP in a single-center, two-armed, parallel-group, superiority, randomized controlled phase II clinical trial. 

The trial, conducted between September 2015 and August 2017 in the Pancreatic Intensive Care Unit (ICU) of the Department of Gastroenterology at the First Affiliated Hospital of Nanchang University. Consenting patients with IAH within 2 weeks of AP onset received conventional treatment for 24 h. Patients with IAP ≥ 12 mmHg were randomized to receive intramuscular neostigmine (1 mg every 12 h increased to every 8 h or every 6 h, depending on response) or continue conventional treatment for 7 days. Percent change of IAP at 24 h after randomization was the primary outcome.