Constipation incidence and impact in medical critical care patients: importance of the definition criterion

• Published in: European journal of gastroenterology & hepatology Vol. 28; no. 3; p. 290
• Main Authors: Prat, Dominique, Messika, Jonathan, Avenel, Alexandre, Jacobs, Frédéric, Fichet, Jérome, Lemeur, Matthieu, Ricard, Jean-Damien, Sztrymf, Benjamin
• Format: Journal Article
• Language: English
• Published: England 01.03.2016
• Subjects: Aged; Constipation - diagnosis; Constipation - epidemiology; Constipation - mortality; Constipation - physiopathology; Critical Care; Critical Illness - epidemiology; Critical Illness - mortality; Defecation; Female; France - epidemiology; Hospital Mortality; Humans; Incidence; Intensive Care Units; Kaplan-Meier Estimate; Length of Stay; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Respiration, Artificial; Risk Factors; Time Factors
• ISSN: 1473-5687
• DOI: 10.1097/MEG.0000000000000543

Constipation incidence and impact remain controversial in the ICU. This may depend on the definition criterion used in the previous studies on the field. We aimed to determine the frequency and significance of constipation according to its definition criterion. This is a prospective observational study. Adult patients without a cause of transit time modification and laxative intake within the first 3 days were screened. Constipation was defined by a first stool passage occurring after 3 days of ICU stay. Thereafter, we identified two subgroups of patients: absence of stool passage more than 3 days but less than 6 days (3-day subgroup), and no stool passage for 6 days or more (6-day subgroup). Survival, length of stay and time spent under mechanical ventilation (MV) were compared according to constipation status. Among 189 included patients [age 60.8 (49.5-74.2) years, SAPS II 44 (34-53)], 98 (51.9%) exhibited constipation (3-day subgroup n=53, 6-day subgroup n=45). Constipated patients were more likely to receive MV, sedation, vasopressors, enteral nutrition and neuromuscular blocking agents. ICU length of stay and time spent under MV was longer in the 6-day subgroup but not in the 3-day subgroup of patients. With regard to outcomes, defining constipation by the absence of stool passage less than 6 days after ICU admission does not identify a specific subset of population. Further studies on the management of this condition should focus on these 'long-term' constipated patients.