TY - JOUR
T1 - Constipation, diarrhea, and prophylactic laxative bowel regimens in the critically ill
T2 - A systematic review and meta-analysis
AU - Hay, Tyler
AU - Bellomo, Rinaldo
AU - Rechnitzer, Tom
AU - See, Emily
AU - Ali Abdelhamid, Yasmine
AU - Deane, Adam M.
PY - 2019/8
Y1 - 2019/8
N2 - Introduction: Prophylactic laxative bowel regimens may prevent constipation in enterally-fed critically ill patients. However, their use may also increase diarrhea. We performed a systematic review to: 1. Explore the epidemiology of constipation and/or diarrhea in critically ill patients; and 2. Appraise trials evaluating prophylactic laxative bowel regimens. Methods: We searched MEDLINE, Embase, and CINAHL for publications that reported constipation or diarrhea in critically ill adult patients and/or prophylactic laxative bowel regimens. Results: The proportion of critically ill patients experiencing constipation was reported between 20% and 83% and the proportion experiencing diarrhea was reported between 3.3% and 78%. Six studies of prophylactic laxative bowel regimens were identified but only 3 randomised controlled trials were identified, and these were subjected to meta-analysis. Compared with placebo, a prophylactic laxative bowel regimen increased the risk of diarrhea (RR 1.58, 95% CI 1.22 to 2.04) but did not reduce the risk of constipation (RR 0.39, 95% CI 0.14 to 1.05), and did not affect the duration of mechanical ventilation, duration of ICU admission, or mortality. Conclusions: Constipation and diarrhea occur frequently in the critically ill but data evaluating prophylactic laxative bowel regimens in such patients are sparse and do not support their use.
AB - Introduction: Prophylactic laxative bowel regimens may prevent constipation in enterally-fed critically ill patients. However, their use may also increase diarrhea. We performed a systematic review to: 1. Explore the epidemiology of constipation and/or diarrhea in critically ill patients; and 2. Appraise trials evaluating prophylactic laxative bowel regimens. Methods: We searched MEDLINE, Embase, and CINAHL for publications that reported constipation or diarrhea in critically ill adult patients and/or prophylactic laxative bowel regimens. Results: The proportion of critically ill patients experiencing constipation was reported between 20% and 83% and the proportion experiencing diarrhea was reported between 3.3% and 78%. Six studies of prophylactic laxative bowel regimens were identified but only 3 randomised controlled trials were identified, and these were subjected to meta-analysis. Compared with placebo, a prophylactic laxative bowel regimen increased the risk of diarrhea (RR 1.58, 95% CI 1.22 to 2.04) but did not reduce the risk of constipation (RR 0.39, 95% CI 0.14 to 1.05), and did not affect the duration of mechanical ventilation, duration of ICU admission, or mortality. Conclusions: Constipation and diarrhea occur frequently in the critically ill but data evaluating prophylactic laxative bowel regimens in such patients are sparse and do not support their use.
KW - Bowel
KW - Constipation
KW - Critical illness
KW - Diarrhea
KW - Laxatives
KW - Mechanical ventilation
UR - http://www.scopus.com/inward/record.url?scp=85060101743&partnerID=8YFLogxK
U2 - 10.1016/j.jcrc.2019.01.004
DO - 10.1016/j.jcrc.2019.01.004
M3 - Article
AN - SCOPUS:85060101743
VL - 52
SP - 242
EP - 250
JO - Journal of Critical Care
JF - Journal of Critical Care
SN - 0883-9441
ER -