A single-centre observational study of delayed defaecation in brain-injured patients in an adult intensive care unit.
Acquired brain injury
Aperients
Bowel management guideline
Delayed defaecation
Intensive care
Traumatic brain injury
Journal
Australian critical care : official journal of the Confederation of Australian Critical Care Nurses
ISSN: 1036-7314
Titre abrégé: Aust Crit Care
Pays: Australia
ID NLM: 9207852
Informations de publication
Date de publication:
11 Aug 2023
11 Aug 2023
Historique:
received:
20
08
2022
revised:
07
07
2023
accepted:
08
07
2023
medline:
14
8
2023
pubmed:
14
8
2023
entrez:
13
8
2023
Statut:
aheadofprint
Résumé
The incidence of delayed defaecation is high in enterally fed ventilated patients in intensive care units (ICUs). Those with brain injury may be harmed by increased intracranial pressure if delayed defaecation leads to abdominal distension. There are no studies evaluating a bowel guideline in the treatment of delayed defaecation in ventilated brain-injured ICU patients. The objective of this study was to assess the incidence and clinical associations of delayed defaecation and level of compliance to an ICU bowel guideline. Data were collected on ventilated adult patients with brain injury admitted for more than 3 days to one New Zealand ICU over a 2-year period. Data were analysed for 117 patients; 56 (48%) who defaecated within 3 days of ICU admission (Group one) and 61 (52%) with delayed defaecation after 3 days (Group two). Compliance with the bowel guideline was low. Only 1 of 61 patients who should have had a rectal examination did so, and only 7 of 61 patients who should have had an aperient on day 3 did so. All seven received Movicol®, which was not part of the guideline. Use of aperients and enemas was found to be associated with stool passage (odds ratio: 93; 95% confidence interval: 5.2-1668; p = 0.002). Patients with delayed defaecation had longer ICU stays (mean 7.1 ± 4 SD vs 5.9 ± 3 days, p = 0.07) and more often had high gastric residual volumes after day 4 (27/61 vs 14/56; p = 0.003). No differences were seen between the groups in the incidence of ventilator-associated pneumonia, bacterial infections, diarrhoea, vomiting, duration of mechanical ventilation, or mortality. Delayed defaecation was common, and compliance with the guideline was low. Movicol® and phosphate enemas were effective in stool production.
Sections du résumé
BACKGROUND
BACKGROUND
The incidence of delayed defaecation is high in enterally fed ventilated patients in intensive care units (ICUs). Those with brain injury may be harmed by increased intracranial pressure if delayed defaecation leads to abdominal distension. There are no studies evaluating a bowel guideline in the treatment of delayed defaecation in ventilated brain-injured ICU patients.
OBJECTIVE
OBJECTIVE
The objective of this study was to assess the incidence and clinical associations of delayed defaecation and level of compliance to an ICU bowel guideline.
METHODS
METHODS
Data were collected on ventilated adult patients with brain injury admitted for more than 3 days to one New Zealand ICU over a 2-year period.
RESULTS
RESULTS
Data were analysed for 117 patients; 56 (48%) who defaecated within 3 days of ICU admission (Group one) and 61 (52%) with delayed defaecation after 3 days (Group two). Compliance with the bowel guideline was low. Only 1 of 61 patients who should have had a rectal examination did so, and only 7 of 61 patients who should have had an aperient on day 3 did so. All seven received Movicol®, which was not part of the guideline. Use of aperients and enemas was found to be associated with stool passage (odds ratio: 93; 95% confidence interval: 5.2-1668; p = 0.002). Patients with delayed defaecation had longer ICU stays (mean 7.1 ± 4 SD vs 5.9 ± 3 days, p = 0.07) and more often had high gastric residual volumes after day 4 (27/61 vs 14/56; p = 0.003). No differences were seen between the groups in the incidence of ventilator-associated pneumonia, bacterial infections, diarrhoea, vomiting, duration of mechanical ventilation, or mortality.
CONCLUSION
CONCLUSIONS
Delayed defaecation was common, and compliance with the guideline was low. Movicol® and phosphate enemas were effective in stool production.
Identifiants
pubmed: 37574388
pii: S1036-7314(23)00096-6
doi: 10.1016/j.aucc.2023.07.002
pii:
doi:
Types de publication
Journal Article
Langues
eng
Informations de copyright
Copyright © 2023 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of interest R Parke is an Editor with Australian Critical Care. As per the journal's policies, this manuscript was managed through the review process by Assoc Prof Buckley, and Parke did not have access to the manuscript during the review process.