{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T22:33:08Z","timestamp":1790289188873,"version":"4.1.0"},"reference-count":51,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,10,23]],"date-time":"2023-10-23T00:00:00Z","timestamp":1698019200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Constipation is frequent in critically ill patients, and potentially related to adverse outcomes. Peripherally\u2010active mu\u2010opioid receptor antagonists (PAMORAs) are approved for opioid\u2010induced constipation, but information on their efficacy and safety in critically ill patients is limited. We present a single\u2010center, retrospective, case\u2010series of the use of naldemedine for opioid\u2010associated constipation, and we systematically reviewed the use of PAMORAs in critically ill patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Case\u2010series included consecutive mechanically\u2010ventilated patients; constipation was defined as absence of bowel movements for &gt;3\u2009days. Naldemedine was administered after failure of the local laxation protocol. Systematic review: PubMed was searched for studies of PAMORAs to treat opioid\u2010induced constipation in adult critically ill patients. Primary outcomes: time to laxation, and number of patients laxating at the shortest follow\u2010up. Secondary outcomes: gastric residual volumes and adverse events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>A total of 13 patients were included in the case\u2010series; the most common diagnosis was COVID\u201019 ARDS. Patients had their first bowel movement 1 [0;2] day after naldemedine. Daily gastric residual volume was 725 [405;1805] before vs. 250 [45;1090] mL after naldemedine, <jats:italic>p<\/jats:italic>\u2009=\u20090.0078. Systematic review identified nine studies (two RCTs, one prospective case\u2010series, three retrospective case\u2010series and three case\u2010reports). Outcomes were similar between groups, with a trend toward a lower gastric residual volume in PAMORAs group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions &amp; Inferences<\/jats:title><jats:p>In a highly\u2010selected case\u2010series of patients with refractory, opioid\u2010associated constipation, naldemedine was safe and associated to reduced gastric residuals and promoting laxation. In the systematic review and meta\u2010analysis, the use of PAMORAs (mainly methylnaltrexone) was safe and associated with a reduced intolerance to enteral feeding but no difference in the time to laxation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.14694","type":"journal-article","created":{"date-parts":[[2023,10,23]],"date-time":"2023-10-23T08:24:47Z","timestamp":1698049487000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Peripherally\u2010active mu\u2010opioid receptor antagonists for constipation in critically ill patients receiving opioids: A case\u2010series and a systematic review and meta\u2010analysis of the literature"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4356-3543","authenticated-orcid":false,"given":"Michele","family":"Umbrello","sequence":"first","affiliation":[{"name":"SC Rianimazione e Anestesia, Ospedale Nuovo di Legnano ASST Ovest Milanese  Legnano 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