Tyler Hay1, Adam M Deane2, Tom Rechnitzer3, Kate Fetterplace4, Rebecca Reilly3, Melissa Ankravs4, Michael Bailey5, Timothy Fazio6, James Anstey4, Rohit D'Costa7, Jeffrey J Presneill4, Christopher M MacIsaac4, Rinaldo Bellomo8. 1. The University of Melbourne, Melbourne Medical School, Parkville, Victoria, Australia. 2. The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, VIC 3050, Australia; Intensive Care Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia. Electronic address: adam.deane@mh.org.au. 3. Intensive Care Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia. 4. The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, VIC 3050, Australia; Intensive Care Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia. 5. Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Australia; The University of Melbourne, Department of Medicine and Radiology, Parkville, Victoria, Australia. 6. The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, VIC 3050, Australia; Business Intelligence Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia. 7. Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Australia. 8. The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, VIC 3050, Australia; Intensive Care Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Australia; Intensive Care Unit, The Austin Hospital, Heidelberg, Victoria, Australia.
Abstract
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).
RCT Entities:
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).
Authors: Joanna C Dionne; Lawrence Mbuagbaw; John W Devlin; Matthew S Duprey; Rodrigo Cartin-Ceba; Jennifer Tsang; Kristen Sullivan; John Muscedere; Mohammed Alshahrani; Wojciech Szczeklik; Paul Lysecki; Alyson Takaoka; Brenda Reeve; Tracy Campbell; Karolina Borowska; Wojciech Serednicki; Robert Cirone; Waleed Alhazzani; Paul Moayyedi; David Armstrong; Lehana Thabane; Roman Jaeschke; Cindy Hamielec; Tim Karachi; Deborah J Cook Journal: Intensive Care Med Date: 2022-04-11 Impact factor: 17.440