***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — Pneumonia is a major cause of mortality and morbidity in patients with stroke fed via nasogastric tubes and may be because of vomiting and gastro-oesophageal regurgitation . The aim of the study was to assess whether regular treatment with metoclopramide , a D2-receptor antagonist with antiemetic and gastric prokinetic actions , could reduce the rate of aspiration and pneumonia . Methods — Patients with no signs of pneumonia within 7 days of stroke onset and 48 hours of insertion of a nasogastric tube were recruited into a double-blind r and omized placebo-controlled trial . Participants received metoclopramide 10 mg or placebo 3 × daily via the nasogastric tube for 21 days or until nasogastric feeds were discontinued . Clinical signs of pneumonia were recorded daily . Pneumonia was diagnosed if the patient had relevant clinical signs , high inflammatory markers , and new infiltrates on the chest radiograph . Results — Sixty patients ( mean age , 78 years ; 38 women ; mean National Institutes for Health Stroke Scale score , 19.25 ) were r and omized in a 1:1 ratio . There were significantly more episodes of pneumonia in the placebo group than in the metoclopramide group ( rate ratio , 5.24 ; P<0.001 ) . There were also significant differences in favor of metoclopramide  in the rate of aspiration , oxygen saturation , highest inflammatory markers , and National Institutes for Health Stroke Scale . There was no significant difference in mortality between the groups . Conclusions — This study suggests that metoclopramide may reduce the rate of pneumonia and may improve other clinical outcomes in patients with subacute stroke fed via nasogastric tube . These findings need to be confirmed in larger r and omized and blinded trials . Clinical Trial Registration — URL : https://www . clinical trialsregister.eu . EudraCT no : 2006 - 002570 - 22 , URL : http://www.controlled-trials.com/IS RCT N18034911/18034911 Purpose This study aim ed to determine if preoperative oral administration of metoclopramide , chlorpromazine , gabapentin , or dexamethasone would effectively reduce postoperative nausea and vomiting ( PONV ) in the first 24 hours after surgery in patients undergoing maxillofacial trauma surgery . Methods One hundred fifty patients with maxillofacial skeletal trauma that need open reduction and internal fixation were r and omly assigned to receive one of the fallowing drugs orally , 1 hour preoperative : 10 mg metoclopramide ( group A ) , 300 mg gabapentin ( group B ) , 100 mg chlorpromazine ( group C ) , 5 mg dexamethasone ( group D ) , and placebo ( group E ) . All patients were observed in the first 24 hours for PONV . Data analysis was done with the SPSS software ( version 19 ) , using chi-square test , Fisher exact test , and multiple logistic regression methods . Results The incidence of vomiting was significantly lower in groups A ( 2/30 ) , B ( 3/30 ) , and C ( 2/30 ) compared with the placebo group ( 9/30 ) ( P < 0.05 ) . Also , the incidence of postoperative nausea was significantly high in the placebo group ( 11/30 ) as compared to treatment groups A ( 2/30 ) , B ( 3/30 ) , and C ( 3/30 ) ( P < 0.05 ) . No significant differences in the incidence of PONV were found between groups D ( 7/30 ) and E ( P > 0.05 ) . Of all demographic variables , anesthesia time ( P = 0.034 ) and surgery time ( P = 0.047 ) were predictors of PONV . Conclusion Our results demonstrated that premedication with oral metoclopramide , gabapentin , or chlorpromazine can significantly decrease the incidence of PONV in patients undergoing maxillofacial trauma surgery Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND Ventilator associated pneumonia is a major cause of morbidity in the intensive care unit . Difficulties in identification of the risk factors , in diagnosing and in prevention , have intensified the problem . OBJECTIVES To measure the incidence of ventilator associated pneumonia in intensive care unit and to identify the risk factors associated . METHODS A prospect i ve observational cohort study was done in which we evaluated 69 patients who were mechanically ventilated for more than 48 hours to find out the development of nosocomial pneumonia and presence or absence of risk factors . Data were subjected to univariate analysis using chi-square and t-test . Level of significance was set at 0.05 . RESULTS Twenty two ( 31.88 % ) out of 69 patients developed ventilator associated pneumonia , majority of them between four days to 14 days . Reintubation , invasive lines , H2 blockers and low PaO2/FiO2 were identified as major risk factors in our study . Enteral feeding via nasogastric tube and use of steroids was not associated with development of ventilator associated pneumonia . The patients with ventilator associated pneumonia had significantly longer duration of mechanical ventilation ( 18.88+/-7.7 days vs 7.36+/-4.19 days ) and stay ( 29+/-17.8 days vs 9.22+/-5.14 days ) . The morality was similar for both the groups with or without ventilator associated pneumonia . CONCLUSION The incidence of ventilator pneumonia is high . Patients requiring prolonged ventilation , re-intubation , more invasive lines and H2 blockers , are at high risk and need special attention towards prevention BACKGROUND AND OBJECTIVE Unguided nasojejunal feeding tube insertion success rates are low . Controversy persists about how to safely and efficiently perform enteral nutrition ( EN ) in critically ill patients . This study explores an innovative blind nasointestinal tube ( NIT ) insertion method and compares nasogastric and nasointestinal feeding . METHODS Seventy critically ill patients admitted to the intensive care unit ( ICU ) were divided r and omly into a nasogastric tube group ( NGT ; n=35 ) and an NIT group ( NIT ; n=35 ) . After bedside NGT and blind-type NIT insertion , tube position was assessed and EN was started on day 1 . Patients ' nutritional status parameters , mechanical ventilation duration , average ICU stay , nutritional support costs , and feeding complications were compared . RESULTS Pre-albumin and transferrin levels on days 7 and 14 were significantly higher in the NIT group than in the NGT group ( p<0.01 , p<0.05 ) . Bloating , diarrhea , upper gastrointestinal bleeding , and liver damage did not differ significantly between groups ( p>0.05 ) . Interleukin-6 and tumor necrosis factor-α levels and APACHE II score were significantly lower in the NIT group than in the NGT group ( p<0.01 , p<0.05 ) . Reflux and pneumonia incidences , mechanical ventilation duration , average ICU stay length , and nutritional support costs were significantly lower in the NIT group than in the NGT group ( p<0.01 ) . CONCLUSION Blind bedside NIT insertion is convenient and its use can effectively improve nutritional status , reduce feeding complications , and decrease nutritional support costs of critically ill patients Background There are numerous challenges in providing nutrition to the mechanically ventilated critically ill ICU patient . Underst and ing the level of nutritional support and the barriers to enteral feeding interruption in mechanically ventilated patients are important to maximise the nutritional benefits to the critically ill patients . Thus , this study aims to evaluate enteral nutrition delivery and identify the reasons for interruptions in mechanically ventilated Malaysian patients receiving enteral feeding . Methods A cross sectional prospect i ve study of 77 consecutive patients who required mechanical ventilation and were receiving enteral nutrition was done in an open 14-bed intensive care unit of a tertiary hospital . Data were collected prospect ively over a 3 month period . Descriptive statistical analysis were made with respect to demographical data , time taken to initiate feeds , type of feeds , quantification of feeds attainment , and reasons for feed interruptions . There are no set feeding protocol s in the ICU . The usual initial rate of enteral nutrition observed in ICU was 20 ml/hour , assessed every 6 hours and the decision was made thereafter to increase feeds . The target calorie for each patient was determined by the clinician alongside the dietitian . The use of prokinetic agents was also prescribed at the discretion of the attending clinician and is commonly IV metoclopramide 10 mg three times a day . Results About 66 % of patients achieved 80 % of caloric requirements within 3 days of which 46.8 % achieved full feeds in less than 12 hours . The time to initiate feeds for patients admitted into the ICU ranged from 0 – 110 hours with a median time to start feeds of 15 hours and the interquartile range ( IQR ) of 6–59 hours . The mean time to achieve at least 80 % of nutritional target was 1.8 days ± 1.5 days . About 79 % of patients experienced multiple feeding interruptions . The most prevalent reason for interruption was for procedures ( 45.1 % ) followed by high gastric residual volume ( 38.0 % ) , diarrhoea ( 8.4 % ) , difficulty in nasogastric tube placement ( 5.6 % ) and vomiting ( 2.9 % ) . Conclusion Nutritional inadequacy in mechanically ventilated Malaysian patients receiving enteral nutrition was not as common as expected . However , there is still room for improvement with regards to decreasing the number of patients who did not achieve their caloric requirement throughout their stay in the ICU OBJECTIVES To investigate the absorption of the gastrokinetic drug , cisapride , and effect of cisapride on gastric emptying in critically ill patients ; and to assess the usefulness of clinical signs of gastric emptying . DESIGN Prospect i ve , r and omized , controlled study . SETTING Medical/surgical/trauma intensive care unit ( ICU ) in a university hospital . PATIENTS Twenty-seven consecutively enrolled patients , aged 18 to 65 yrs , with normal hepatic and renal biochemistry who were not receiving enteral nutrition and who had no contraindications to enteral nutrition . These patients were expected to stay in the ICU for at least 4 days . INTERVENTIONS Patients were r and omized to receive either placebo or rectal cisapride , 60 mg initially followed by two doses of 30 mg at 8-hr intervals . MEASUREMENTS AND MAIN RESULTS Gastric emptying was estimated , using acetaminophen absorption on day 1 of the study . Placebo or cisapride was administered and a second acetaminophen absorption test for gastric emptying was carried out on day 2,24 hrs after the first test . Four patients were excluded because of incomplete data . Statistical analysis was performed , using the area under the acetaminophen absorption curve from 0 to 60 mins as the primary measure of gastric emptying . There was no significant change in the area under the acetaminophen absorption curve from 0 to 60 mins from day 1 to day 2 in patients who received placebo or cisapride . Using the combination of the time to maximum acetaminophen concentration ( < or = 30 mins ) with a maximum concentration ( > 12 mg/L ) to define " normal " emptying , on day 1 , four of the 11 placebo patients had the " normal " gastric emptying , and by day 2 , five patients fulfilled this criterion . Before administration of cisapride , four of the 12 patients fulfilled this criterion , whereas nine fulfilled the criterion after receiving cisapride . There was a large variation in gastric emptying from day 1 to day 2 ; a power calculation suggests that approximately 150 patients would have to be studied to determine the effect of cisapride . There was no correlation between gastric emptying and the volume of gastric aspirate or the presence of bowel sounds . Plasma cisapride concentrations 4 hrs after the third dose , during the second acetaminophen absorption test , averaged 53 ng/mL ( range 20 to 111 ) . CONCLUSIONS Rectal cisapride in the dose given achieved average plasma concentrations similar to those concentrations achieved in healthy subjects after 30 mg of cisapride rectally . There is a large variation in gastric emptying from one day to the next and large numbers of patients are required to determine if cisapride administration improves early gastric emptying in critically ill patients . The volume of gastric aspirate and the presence of bowel sounds do not correlate with gastric emptying PURPOSE The prupose was to identify , through the BreathID automatic breath-testing device , the best prokinetic therapy to enhance gastric-emptying rate ( GER ) in ventilated intensive care unit patients . MATERIAL S AND METHODS This was a prospect i ve , crossover , nonr and omized study . Consecutive ventilated patients who could be fed enterally and expected to require 5 days of ventilation were included .  (13)C- 
    Output:
    
Because of the poor method ological 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 .