Impaired gastrointestinal transit and its associated morbidity in the intensive care unit

• Published in: Journal of critical care 2013-08, Vol.28 (4), p.537.e11-537.e17
• Main Authors: Nguyen, Tiffany, BSc. Pharm, Frenette, Anne-Julie, BPharm, MSc, Johanson, Christel, BScPharm, MacLean, Robert D., BScPharm, PharmD, BCPS, Patel, Rakesh, PharmD, MSc, MD, Simpson, Allison, RD, Singh, Avinder, BSc, Pharm, Balchin, Katelyn S., MSc, Fergusson, Dean, PhD, Kanji, Salmaan, BScPharm, PharmD
• Format: Article
• Language: English
• Subjects: Abdomen; APACHE; Bowel; Chi-Square Distribution; Confidence intervals; Constipation; Constipation - diagnosis; Critical Care; Critical Illness; Enteral Nutrition; Female; Gastrointestinal disease; Gastrointestinal Transit; Hospitalization; Humans; Ileus; Ileus - diagnosis; Intensive care; Intensive care unit; Intensive Care Units; Male; Middle Aged; Morbidity; Mortality; Motility; Nutrition; Ostomy; Parenteral nutrition; Patients; Postoperative period; Prospective Studies; Regression Analysis; Respiration, Artificial; Risk Factors; Surgery
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2012.12.003

Abstract Purpose To determine the proportion of critically ill adults developing impaired gastrointestinal transit (IGT) using a clinically pragmatic definition, its associated morbidity and risk factors. Materials and Methods Critically ill adult patients receiving enteral nutrition for ≥ 72 hours and mechanically ventilated for ≥ 48 hours were prospectively identified. IGT was defined as absence of a bowel movement for ≥ 3 days, treatment for constipation, and one of the following: (1) radiologic confirmed ileus, (2) feed intolerance, (3) abdominal distention, or (4) gastric decompression. Results One thousand patients were screened, and 248 were included for analysis. Fifty patients (20.1%; 95% confidence interval, 15.1-25.6%) developed IGT persisting for 6.5 ± 2.5 days. Patients with IGT had longer lengths of intensive care unit stay and were less likely to reach nutrition targets compared to patients without IGT or traditional definitions of constipation. Daily opioid use and pharmacological constipation prophylaxis were identified risk factors for IGT. Conclusion Traditional definitions of constipation or ileus in intensive care unit patients are simplistic and lack clinical relevance. Pragmatically defined IGT is a common complication of critical illness and is associated with significant morbidity. Future interventional studies for IGT in critically ill adults should use a more clinically relevant definition and evaluate energy deficits and lengths of stay as clinically relevant outcomes.