967

Abstract

Introduction: Enteral nutrition is the preferred method for nutrition in the PICU but is associated with complications including constipation and abdominal distention. No studies have evaluated the outcomes of a bowel regimen (BR) in critically-ill children. In Fall 2010, a comprehensive feeding protocol and BR protocol were initiated in our institution. Six age-based protocols were developed,each of which included a four-step approach. Hypothesis: The objectives of this pilot study were to retrospectively evaluate the outcomes of the six-age based BR protocols and to identify necessary revisions to the BR. Methods: This retrospective study evaluated children <18 years of age who received the BR between July 18, 2010 and April 13, 2012. Data collection included demographics, stool type/frequency, opioid exposure, and BR dosing regimen. The primary objective was to determine the percentage of patients requiring BR escalation beyond Step 1. Secondary objectives included the number of patients with a protocol deviation and the frequency of adverse events. Descriptive and inferential statistics were performed. A multiple logistic regression was employed to assess the need for protocol escalation beyond Step 1. Data analyses were conducted using Stata v10.1, with a p-value <0.05. Results: Fifty-four patients were included. The majority were male with a median age of 0.25 years (range 0.08-15). Forty-three (79.6%) patients received opioid continuous infusions. The BR was initiated on ICU day 1 (range 1-25). Thirty patients (55.6%) required escalation beyond Step 1. All patients who received Step 2 and Step 3 had a protocol deviation. Opioid duration was significantly associated with protocol escalation (odds ratio, 0.83; 95% confidence interval 0.689-0.997; p=0.047). Conclusions: The pilot study is the first to describe the outcomes of the implementation of a four-step BR in critically-ill children. Half of all patients required escalation of the BR beyond Step 1. A number of patients deviated from the protocol. Opioid duration was independently associated with protocol escalation. Future studies should focus on the optimal regimen to alleviate constipation in critically-ill children.