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4CPS-135 Evaluation and management of constipation in the critically ill patient
  1. A Puertas Sanjuan1,
  2. L Domenech Morales1,
  3. J Santander Reboreda1,
  4. S Fernandez Molina1,
  5. A Nieto Ruiz2,
  6. L Vidal Tarrason2,
  7. MQ Gorgas Torner1
  1. 1Vall D’hebron University Hospital, Hospital Pharmacy Department, Barcelona, Spain
  2. 2Vall D’hebron University Hospital, Intensive Care Department, Barcelona, Spain


Background and Importance Constipation (CIN) is a prevalent concern in critically ill patients (CIP) within intensive care units (ICU), potentially exacerbating their condition.

Aim and Objectives Evaluate the management of CIN in CIP, discern its causes and consequences, and propose prophylactic and therapeutic measures.

Material and Methods A descriptive observational study was conducted in a tertiary-level hospital’s ICU. Demographic data, medical history, enteral nutrition (EN) type, factors influencing constipation (treatment regimens, clinical status, and devices), stool history in the last week, and interventions were collected through a cross-sectional approach. CIN was defined as ‘absence of stool after 3 days from the start of the EN/oral diet’. Sixty-three patients were reviewed, and 20 were excluded. Exclusion criteria: admission less than 3 days and no oral/NE tolerance.

Results Forty-three patients were included, with a mean age of 57±13.4 years and an average stay of 23±16.7 days. 58% suffered CIN. The patients showed a mean of 2.93±2.61 days since the last stool and 3.98±2.13 days without stool in the last 7 days. Mobility grades 0 and 2 were predominant (37.21%; 25.58%), with 81.40% requiring mechanical ventilation; of these, 62.8% suffered CIN. The most prevalent diseases were respiratory (46.51%), septic shock (25.58%), and neurological (23.26%). Opioids (53.49%) were the most common pharmacological treatment; 73% suffered CIN. Non-fibre diets (48.9%) were the most commonly used EN; 57% of these patients suffered CIN. Only 39.5% received a fibre-rich diet, with a 64.7% constipation incidence. Laxatives (25.6%), followed by enemas (16.3%), were the most used. CIN was elevated in both groups (72%; 71%). Prokinetics were used in 13.9% of patients and in combination with laxatives in 6.9%. No intervention was applied to 46.5% of patients, 50% of whom had CIN. Lactulose (50%), followed by magnesium hydroxide (37.5%), were the most commonly used laxatives. The most common enema used was Casen® in 85% of patients.

Conclusion and Relevance This study’s implications are significant, highlighting the necessity for vigilant monitoring of CIN-inducing medications in critically ill patients, early implementation of high-fibre diets, and the proactive use of laxatives and prokinetics, possibly in combination. Furthermore, the study underscores the urgency of creating a standardised protocol for CIN prophylaxis and management in ICU settings.

Conflict of Interest No conflict of interest.

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