Patel PB, Brett SJ, O’Callaghan D, et al. - Whether opioid-induced constipation (OIC) in critical care patients could be reversed with methylnaltrexone, a pure peripheral mu-opioid receptor antagonist, was determined in this multi-centre, double blind, randomised placebo-controlled trial, the MOTION trial. This study was performed with adult ICU patients who were mechanically ventilated, taking opioids and were constipated despite previous administration of regular laxatives according to local bowel management protocol. Overall 41 patients were randomized to methylnaltrexone and 43 to placebo. The groups showed no significant variation in time to rescue-free laxation. No evidence favoring methylnaltrexone addition to regular laxatives for the management of OIC in critically ill patients was found in this study; however, wide confidence interval was reported and a clinically significant difference could not be excluded.