1003

Abstract

Introduction: Constipation is common in critically ill patients and is associated with adverse consequences. We modified a bowel regimen previously evaluated in 10 intensive care unit (ICU) patients (Intensive Crit Care Nurs 2004; 20:320-329) to include the stool softener docusate for the duration of the five-day regimen. The regimen escalates to senna (stimulant laxative) on day 3 and lactulose (osmotic laxative) on days 4 and 5 if defecation does not occur during the initial 3 days. Hypothesis: The ICU bowel regimen is effective for promoting defecation in critically ill patients. Methods: Critically ill patients admitted to ICU and initiated on the ICU bowel regimen from March 2011 to March 2012 were included retrospectively. The inclusion criterion for regimen initiation was? 3 days from hospital admission without defecation. Exclusion criteria were admission for gastrointestinal surgery, ileus or acute intestinal obstruction, confounding medications (e.g., lactulose for hepatic encephalopathy), and allergy to regimen medications. Demographic data, vasopressor and opioid use, amount of enteral nutrition (EN), incidence and onset of defecation and diarrhea, and incidence of protocol violations (i.e., senna and/or lactulose continued after first defecation occurred) were evaluated during the five-day regimen. Descriptive statistics were used. Results: 50 patients were included. Demographic characteristics: males (62%); mean ± SD, age (64 ± 14 years); mean ± SD, APACHE II score (22 ± 7); admission diagnosis of respiratory failure/pneumonia (66%). Vasopressors and opioids were used in 14% and 62% of patients. Mean ± SD time to initiation of EN was 2 ± 2 days. All patients received >50% of their EN goal by day 3 of the regimen. Mean ± SD time period without defecation prior to regimen initiation was 4 ± 2 days. Defecation occurred in 94% of patients. Protocol violations occurred in 12 patients. Incidence of diarrhea was 20% after correction for protocol violations. Mean ± SD time to onset of diarrhea and time to first defecation was 3 ± 1 days. Conclusions: Although the incidence of diarrhea observed is higher than desired, the ICU bowel regimen is an effective means of promoting defecation in critically ill patients.