TY - JOUR
T1 - The hospital-based evaluation of laxative prophylaxis in ICU (HELP-ICU)
T2 - A pilot cluster-crossover randomized clinical trial
AU - Hay, Tyler
AU - Deane, Adam M.
AU - Rechnitzer, Tom
AU - Fetterplace, Kate
AU - Reilly, Rebecca
AU - Ankravs, Melissa
AU - Bailey, Michael
AU - Fazio, Timothy
AU - Anstey, James
AU - D'Costa, Rohit
AU - Presneill, Jeffrey J.
AU - MacIsaac, Christopher M.
AU - Bellomo, Rinaldo
PY - 2019/8
Y1 - 2019/8
N2 - Purpose: Prophylactic laxative regimens may prevent constipation but may increase diarrhea and subsequent rectal tube insertion. Our aim was to compare three prophylactic laxative regimens on the rate of rectal tube insertion (primary outcome) and major constipation- or diarrhea-associated complications. Material and Methods: We conducted a cluster-crossover trial. Three pods in a single ICU were each randomized to one of three regimens for four months with rolling cross-over. All mechanically-ventilated and enterally-fed adult patients received either regimen: A) one coloxyl with senna BD from day one; B) two coloxyl with senna +20 ml lactulose BD commencing on day 3; or C) two coloxyl with senna tablets +20 ml lactulose BD commencing on day 6. Results: We enrolled 570 patients (A = 170, B = 205, C = 195) with similar baseline features. Overall, 53 (9.3%) patients received a rectal tube, and insertion rate was not statistically different between the three regimens (A = 12.9%, B = 7.8%, C = 7.7%; p = 0.15). The proportions of patients with other major constipation- or diarrhea-associated complications were similar, as were major patient-centred outcomes. Conclusion: Earlier commencement of a prophylactic coloxyl-based laxative regimen (day 1 or 3) did not affect the rates of complications associated with constipation or diarrhea when compared to delayed introduction (day 6).
AB - Purpose: Prophylactic laxative regimens may prevent constipation but may increase diarrhea and subsequent rectal tube insertion. Our aim was to compare three prophylactic laxative regimens on the rate of rectal tube insertion (primary outcome) and major constipation- or diarrhea-associated complications. Material and Methods: We conducted a cluster-crossover trial. Three pods in a single ICU were each randomized to one of three regimens for four months with rolling cross-over. All mechanically-ventilated and enterally-fed adult patients received either regimen: A) one coloxyl with senna BD from day one; B) two coloxyl with senna +20 ml lactulose BD commencing on day 3; or C) two coloxyl with senna tablets +20 ml lactulose BD commencing on day 6. Results: We enrolled 570 patients (A = 170, B = 205, C = 195) with similar baseline features. Overall, 53 (9.3%) patients received a rectal tube, and insertion rate was not statistically different between the three regimens (A = 12.9%, B = 7.8%, C = 7.7%; p = 0.15). The proportions of patients with other major constipation- or diarrhea-associated complications were similar, as were major patient-centred outcomes. Conclusion: Earlier commencement of a prophylactic coloxyl-based laxative regimen (day 1 or 3) did not affect the rates of complications associated with constipation or diarrhea when compared to delayed introduction (day 6).
KW - Constipation
KW - Critically ill
KW - Diarrhea
KW - Enteral nutrition
KW - Laxatives
KW - Rectal tube
UR - http://www.scopus.com/inward/record.url?scp=85064231204&partnerID=8YFLogxK
U2 - 10.1016/j.jcrc.2019.04.010
DO - 10.1016/j.jcrc.2019.04.010
M3 - Article
C2 - 30986760
AN - SCOPUS:85064231204
VL - 52
SP - 86
EP - 91
JO - Journal of Critical Care
JF - Journal of Critical Care
SN - 0883-9441
ER -