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Tobben D, Carpenter S, Kolar R, Merritt T, Young T, Hauser P, Collier T. Naloxegol versus Methylnaltrexone for Opioid-Induced Constipation in Critically Ill Patients. Ann Pharmacother 2024; 58:678-684. [PMID: 37881915 DOI: 10.1177/10600280231205023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Constipation impacts 58% to 83% of critically ill patients and is associated with increased time on mechanical ventilation, delirium, and increased length of stay (LOS) in the intensive care unit (ICU). OBJECTIVE The purpose of this study was to evaluate the efficacy of enteral naloxegol (NGL) versus subcutaneous methylnaltrexone (MNTX) for the management of opioid-induced constipation (OIC) in critically ill patients. METHODS A retrospective analysis was conducted on adult patients admitted to the ICU who received a parenteral opioid infusion for at least 4 hours and experienced no bowel movement (BM) within the 48-hour period preceding the administration of NGL or MNTX. The primary outcome was time to first BM from the start of NGL or MNTX therapy. Secondary outcomes included number of BMs 72 hours following NGL or MNTX administration, ICU LOS, and cost-effectiveness. RESULTS After exclusion criteria were applied, 110 and 51 patients were included in the NGL and MNTX groups, respectively. With a 10% noninferiority margin, NGL was noninferior to MNTX (Wald statistic = 1.67; P = 0.047). Median time to first BM was 23.7 hours for NGL and 18.3 hours for MNTX patients. Median LOS was 14 days (NGL) and 12 days (MNTX), and the average number of BMs in 72 hours was 3.9 for NGL and 3.8 for MNTX. Using wholesale acquisition cost (WAC), the cost per BM for NGL and MNTX was $21.74 and $170.00, respectively. CONCLUSION AND RELEVANCE This study determined that NGL and MNTX had similar time to BM. NGL appears to be a safe and effective alternative with cost-saving potential in treating OIC in critically ill patients.
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Affiliation(s)
- Daniel Tobben
- Department of Pharmacy, UNC Health Rex, Raleigh, NC, USA
| | | | - Rachel Kolar
- Department of Pharmacy, UNC Health Rex, Raleigh, NC, USA
| | - Tyler Merritt
- Department of Pharmacy, UNC Health Rex, Raleigh, NC, USA
| | - Tramaine Young
- Department of Pharmacy, UNC Health Rex, Raleigh, NC, USA
| | - Paloma Hauser
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Tia Collier
- Department of Pharmacy, UNC Health Rex, Raleigh, NC, USA
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2
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Roller MD, Panchal A, Duesing L, Mikhailov TA. Incidence of opioid-induced constipation in the pediatric intensive care unit: A descriptive cohort study. JPEN J Parenter Enteral Nutr 2024; 48:354-359. [PMID: 38142301 DOI: 10.1002/jpen.2592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/23/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Opioid-induced constipation (OIC) is a well-known phenomenon, although there is limited literature evaluating the incidence of OIC in children admitted to the pediatric intensive care unit (PICU). The primary aim of this study was to determine the incidence of OIC in the PICU and to determine if it is associated with a higher rate of morbidities or prolonged length of stay (LOS). METHODS We conducted a single-center retrospective chart review from July 1, 2014, to June 30, 2015, in our PICU. We included all patients aged ≤18 years with a PICU stay of ≥96 h who received opioids during their admission. Data were collected on the frequency of bowel movements and characteristics of opioid administration. Demographic and clinical data were obtained from Virtual Pediatric Systems, LLC. RESULTS Of the 94 patients who met the study criteria, 39.4% developed constipation. These patients tended to be older (P = 0.06) and were noted to weigh more (P = 0.03). There was no significant difference in the total or median daily doses, duration of opioid treatment, or mode of administration. Constipation rates did not differ by the severity of illness. There was a higher incidence of constipation in the patients who were admitted for neurological issues or after trauma or abdominal surgery (P = 0.002). Patients with constipation had a longer LOS than patients without constipation, but the difference was not statistically significant. CONCLUSION These results indicate that opioid use is not the sole risk factor for constipation in the PICU setting.
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Affiliation(s)
- Meghan D Roller
- Department of Pediatrics, Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Apurva Panchal
- Critical Care, Children's Mercy Hospital and Clinics, Kansas City, Missouri, USA
| | - Lori Duesing
- Children's Wisconsin, Milwaukee, Wisconsin, USA
- Department of General Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Theresa A Mikhailov
- Department of Pediatrics, Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Children's Wisconsin, Milwaukee, Wisconsin, USA
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Liu X, Yu N, Lu H, Zhang P, Liu C, Liu Y. Effect of opioids on constipation in critically ill patients: A meta-analysis. Aust Crit Care 2024; 37:338-345. [PMID: 37586897 DOI: 10.1016/j.aucc.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/09/2023] [Accepted: 06/11/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES This meta-analysis evaluated the effect of opioids on constipation in ICU patients. REVIEW METHOD USED Systematic review and meta-analysis. DATA SOURCES PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang DATA databases. REVIEW METHODS Random or fixed-effects meta-analyses were used. Subgroup analysis was performed according to the definition of constipation (three vs. six days), opioids (fentanyl vs. morphine), study design (prospective vs. retrospective), adjustment of confounders (No vs. Yes), and patient's age (adults vs. children). We used sensitivity analysis to test the robustness of results with significant statistical heterogeneity. RESULTS Seven studies (2264 patients) were included. Opioid use in ICU patients was associated with an increased risk of constipation (relative risk [RR]=1.14; 95% confidence interval [CI]=1.05 to 1.24; I2=49.8%). Subgroup analysis further showed that adjustment form, category of opioid, study design, and patient's age significantly influenced the relationship between opioid use and the risk of constipation. Sensitivity analysis confirmed the robustness of pooled results. CONCLUSION Opioids significantly increase the risk of constipation in critically ill patients, especially children. It is worth noting that the adjustment of the constipation definition used for ICU significantly influenced the relationship between opioid use and the risk of constipation. Therefore, It is necessary to clearly define ICU constipation and conduct time-based layered treatment. Additional prospective studies are needed to investigate the consistent definition of ICU constipation.
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Affiliation(s)
- Xuefang Liu
- Department of Anesthesiology and Intensive Care Unit, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ning Yu
- Department of Anesthesiology and Intensive Care Unit, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huaihai Lu
- Department of Anesthesiology and Intensive Care Unit, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Pei Zhang
- Department of Anesthesiology and Intensive Care Unit, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chao Liu
- Department of Anesthesiology and Intensive Care Unit, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ya Liu
- Department of Anesthesiology and Intensive Care Unit, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
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Umbrello M, Venco R, Palandri C, Racagni M, Muttini S. Peripherally-active mu-opioid receptor antagonists for constipation in critically ill patients receiving opioids: A case-series and a systematic review and meta-analysis of the literature. Neurogastroenterol Motil 2023; 35:e14694. [PMID: 37869768 DOI: 10.1111/nmo.14694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 09/15/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Constipation is frequent in critically ill patients, and potentially related to adverse outcomes. Peripherally-active mu-opioid receptor antagonists (PAMORAs) are approved for opioid-induced constipation, but information on their efficacy and safety in critically ill patients is limited. We present a single-center, retrospective, case-series of the use of naldemedine for opioid-associated constipation, and we systematically reviewed the use of PAMORAs in critically ill patients. METHODS Case-series included consecutive mechanically-ventilated patients; constipation was defined as absence of bowel movements for >3 days. Naldemedine was administered after failure of the local laxation protocol. Systematic review: PubMed was searched for studies of PAMORAs to treat opioid-induced constipation in adult critically ill patients. PRIMARY OUTCOMES time to laxation, and number of patients laxating at the shortest follow-up. SECONDARY OUTCOMES gastric residual volumes and adverse events. KEY RESULTS A total of 13 patients were included in the case-series; the most common diagnosis was COVID-19 ARDS. Patients had their first bowel movement 1 [0;2] day after naldemedine. Daily gastric residual volume was 725 [405;1805] before vs. 250 [45;1090] mL after naldemedine, p = 0.0078. Systematic review identified nine studies (two RCTs, one prospective case-series, three retrospective case-series and three case-reports). Outcomes were similar between groups, with a trend toward a lower gastric residual volume in PAMORAs group. CONCLUSIONS & INFERENCES In a highly-selected case-series of patients with refractory, opioid-associated constipation, naldemedine was safe and associated to reduced gastric residuals and promoting laxation. In the systematic review and meta-analysis, the use of PAMORAs (mainly methylnaltrexone) was safe and associated with a reduced intolerance to enteral feeding but no difference in the time to laxation.
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Affiliation(s)
- Michele Umbrello
- SC Rianimazione e Anestesia, Ospedale Nuovo di Legnano, ASST Ovest Milanese, Legnano, Italy
| | - Roberto Venco
- SC Anestesia e Rianimazione II, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Chiara Palandri
- SC Anestesia e Rianimazione II, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Milena Racagni
- SC Anestesia e Rianimazione II, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Stefano Muttini
- SC Anestesia e Rianimazione II, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milano, Italy
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Danielis M, Mattiussi E, Piani T, Iacobucci A, Tullio A, Molfino A, Vetrugno L, Deana C. Diarrhoea and constipation during artificial nutrition in intensive care unit: A prospective observational study. Clin Nutr ESPEN 2023; 57:375-380. [PMID: 37739681 DOI: 10.1016/j.clnesp.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE To describe the occurrence of gastrointestinal (GI) complications, specifically diarrhoea and constipation, in artificially (enterally or parenterally) fed critically ill patients within their first seven-day stay in Intensive Care Unit (ICU). METHODS Observational prospective study conducted from September 1st to October 30th, 2019 and from August 1st to October 30th, 2021, in an ICU of a 1000-bed third-level hospital. General characteristics, nutritional variables, and medications administered were recorded and analysed. This study was registered on ClinicalTrials.gov (Identifier: NCT05473546). RESULTS In total, 100 critically ill patients were included. Diarrhoea was present in 44 patients (44.0%), while constipation occurred in 22 (22.0%) patients. Patients with diarrhoea were generally those admitted for respiratory failure, whereas patients without diarrhoea were mostly affected by neurological disorders (22.7% vs 25%, respectively; p = 0.002). Likewise, patients with constipation were primarily those admitted for trauma (36.4%). Trauma patients were almost 24 times more likely to be constipated than patients with respiratory failure (OR 23.99, CI 1.38-418.0) and patients receiving diuretics were over 16 times more likely to have diarrhoea than patients not receiving diuretics (OR 16.25, IC 1.89-139.86). CONCLUSION GI complications of enteral nutrition represent still a very common issue in ICU. The main predictor of constipation was an admission for trauma whereas the main predictor of diarrhoea was the use of diuretics. Clinicians should consider and integrate these findings into more personalized nutritional and management protocols to avoid gastrointestinal complications.
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Affiliation(s)
- Matteo Danielis
- Department of Anesthesia and Intensive Care, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine, Piazzale Santa Maria della Misericordia 15, Udine, Italy; Laboratory of Studies and Evidence Based Nursing, Department of Medicine, University of Padua, Italy
| | - Elisa Mattiussi
- School of Nursing, Department of Medical Sciences, University of Udine, Viale Ungheria 20, 33100, Udine, Italy
| | - Tommaso Piani
- Department of Anesthesia and Intensive Care, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine, Piazzale Santa Maria della Misericordia 15, Udine, Italy
| | - Anna Iacobucci
- Department of Anesthesia and Intensive Care, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine, Piazzale Santa Maria della Misericordia 15, Udine, Italy
| | - Annarita Tullio
- Hygiene and Clinical Epidemiology Unit, Health Integrated Agency Friuli Centrale, Piazzale Santa Maria della Misericordia 15, Udine, Italy
| | - Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy; Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, 66100 Chieti, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine, Piazzale Santa Maria della Misericordia 15, Udine, Italy.
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He Y, Zheng J, Ye B, Dai Y, Nie K. Chemotherapy-induced gastrointestinal toxicity: Pathogenesis and current management. Biochem Pharmacol 2023; 216:115787. [PMID: 37666434 DOI: 10.1016/j.bcp.2023.115787] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023]
Abstract
Chemotherapy is the most common treatment for malignant tumors. However, chemotherapy-induced gastrointestinal toxicity (CIGT) has been a major concern for cancer patients, which reduces their quality of life and leads to treatment intolerance and even cessation. Nevertheless, prevention and treatment for CIGT are challenging, due to the prevalence and complexity of the condition. Chemotherapeutic drugs directly damage gastrointestinal mucosa to induce CIGT, including nausea, vomiting, anorexia, gastrointestinal mucositis, and diarrhea, etc. The pathogenesis of CIGT involves multiple factors, such as gut microbiota disorders, inflammatory responses and abnormal neurotransmitter levels, that synergistically contribute to its occurrence and development. In particular, the dysbiosis of gut microbiota is usually linked to abnormal immune responses that increases inflammatory cytokines' expression, which is a common characteristic of many types of CIGT. Chemotherapy-induced intestinal neurotoxicity is also a vital concern in CIGT. Currently, modern medicine is the dominant treatment of CIGT, however, traditional Chinese medicine (TCM) has attracted interest as a complementary and alternative therapy that can greatly alleviate CIGT. Accordingly, this review aimed to comprehensively summarize the pathogenesis and current management of CIGT using PubMed and Google Scholar databases, and proposed that future research for CIGT should focus on the gut microbiota, intestinal neurotoxicity, and promising TCM therapies, which may help to develop more effective interventions and optimize managements of CIGT.
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Affiliation(s)
- Yunjing He
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Jingrui Zheng
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Binbin Ye
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Yongzhao Dai
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Ke Nie
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou 510006, China.
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Zhang C, Wang L, Liu X, Wang G, Guo X, Liu X, Zhao J, Chen W. The Different Ways Multi-Strain Probiotics with Different Ratios of Bifidobacterium and Lactobacillus Relieve Constipation Induced by Loperamide in Mice. Nutrients 2023; 15:4230. [PMID: 37836514 PMCID: PMC10574055 DOI: 10.3390/nu15194230] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023] Open
Abstract
Constipation is currently one of the most common gastrointestinal disorders, and its causes are diverse. Multi-strain probiotics are often considered a more effective treatment than single-strain probiotics. In this study, a constipation model was constructed using loperamide hydrochloride to evaluate the ability of a multi-strain probiotic combination of four different ratios of Bifidobacterium and Lactobacillus to regulate intestinal flora, relieve constipation, and explore the initial mechanism in mice. After four weeks of probiotic intervention, BM1, BM2, and PB2 effectively relieved constipation; however, the pathways involved were different. The Bifidobacteria-dominated formulations BM1 and BM2 mainly changed the composition and structure of the intestinal flora and significantly decreased the relative abundance of Tyzzerella, Enterorhabdus, Faecalibaculum, Gordonibacter, and Mucispirillum in stool; increased the relative abundance of Parabacteroides and the content of short-chain fatty acids (SCFAs) in stool; restored motilin (MTL) and vasoactive intestinal peptide (VIP) levels; and downregulated interleukin 6 (IL-6) and IL-8 levels in serum. This repaired the inflammatory response caused by constipation. Finally, it promoted peristalsis of the gastrointestinal tract, increasing stool water content, and relieving constipation. While Lactobacillus-dominated formula PB2 mainly restored the levels of serum neurotransmitters (MTL, SP (substance P), VIP and PYY (Peptide YY)) and inflammatory factors (IL-1, IL-6 and IL-8), it significantly decreased the relative abundance of Tyzzerella, Enterorhabdus, Faecalibaculum, Gordonibacter and Mucispirillum in stool; it then increased acetic acid content, thereby reducing the level of inflammation and changing stool properties and gastrointestinal motility.
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Affiliation(s)
- Chenyue Zhang
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (C.Z.); (X.L.); (G.W.); (J.Z.); (W.C.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Linlin Wang
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (C.Z.); (X.L.); (G.W.); (J.Z.); (W.C.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- (Yangzhou) Institute of Food Biotechnology, Jiangnan University, Yangzhou 225004, China
| | - Xiaoming Liu
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (C.Z.); (X.L.); (G.W.); (J.Z.); (W.C.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- (Yangzhou) Institute of Food Biotechnology, Jiangnan University, Yangzhou 225004, China
| | - Gang Wang
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (C.Z.); (X.L.); (G.W.); (J.Z.); (W.C.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- (Yangzhou) Institute of Food Biotechnology, Jiangnan University, Yangzhou 225004, China
| | - Xinmei Guo
- JinQiao Biotechnology Co., Ltd., Huai’an 223010, China; (X.G.); (X.L.)
| | - Xuecong Liu
- JinQiao Biotechnology Co., Ltd., Huai’an 223010, China; (X.G.); (X.L.)
| | - Jianxin Zhao
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (C.Z.); (X.L.); (G.W.); (J.Z.); (W.C.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- (Yangzhou) Institute of Food Biotechnology, Jiangnan University, Yangzhou 225004, China
| | - Wei Chen
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (C.Z.); (X.L.); (G.W.); (J.Z.); (W.C.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
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Sayuk GS, Yu QT, Shy C. Management of Constipation in Hospitalized Patients. J Clin Med 2023; 12:6148. [PMID: 37834791 PMCID: PMC10573544 DOI: 10.3390/jcm12196148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
Constipation is frequently encountered in hospital settings and can have potentially serious consequences yet is often underrecognized and undertreated. Opioid-induced constipation is a common cause of constipation in hospitalized patients. Opioids induce constipation through agonistic effects on enteric µ-opioid receptors. This review aims to provide insight on the identification and management of constipation in inpatient settings, with a particular focus on opioid-induced constipation. Constipation assessment should be routinely initiated at hospital admission and can be facilitated by thorough symptom assessments; relevant patient history, including recent medication use; physical examination; and patient assessment tools developed to evaluate the impact of constipation. Management of opioid-induced constipation should begin with ensuring adequate hydration and electrolyte balance and encouraging patient mobilization. Other treatments may include laxatives, enemas, intestinal secretagogues, peripherally acting µ-opioid receptor antagonists, and manual disimpaction. Surgical intervention may be required for some patients as a salvage therapy in severe, refractory cases.
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Affiliation(s)
- Gregory S. Sayuk
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Qi T. Yu
- Hospice and Palliative Medicine, Loma Linda University Health, Loma Linda, CA 92354, USA
| | - Corey Shy
- Division of Hospital Medicine, Department of Medicine, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA
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López J, Sánchez C, Fernández SN, González R, Solana MJ, Urbano J, López-Herce J. Development and validation of a clinical score for early diagnosis of constipation in critically ill children. Sci Rep 2023; 13:14822. [PMID: 37684310 PMCID: PMC10491593 DOI: 10.1038/s41598-023-41674-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
Constipation affects almost 50% of critically ill pediatric patients and is related to their morbidity and mortality. However, little attention is paid to it and it is diagnosed late and when there are already complications. The objective of this study is to develop and validate a score to identify critically ill children with high risk of constipation 48 h after admission. A single center two phase-study was carried out; the first one (retrospective observational study) to develop the score and the second one to validate it in another prospective observational study. Children between 15 days of life and 18 years old admitted to the PICU for more than 3 days were included. Demographic and clinical data during the first 48 h after PICU admission were collected. Univariate and multivariate analysis and ROC curves were used to develop and validate the score. Data from 145 patients (62.8% boys) with a mean age of 34.9 ± 7.3 months were used to develop the score. Independent factors identified to develop the score were: weight > 7 kg, admission to PICU after surgery, need of vasoconstrictors, doses of fentanyl ≥ 2 mcg/kg/h, and initiation of enteral nutrition later than 48 h after admission. Two cut-off values were identified to set low constipation risk (< 5.7 points) and high constipation risk (> 6.2 points). This score was validated in 124 patients showing a sensibility of 63.2%, specificity of 95.5% and a positive/negative predictive values (P/NPV) of 100% and 82.1% respectively to identify constipated patients. This is the first score to identify high constipation risk in critically ill children. This score is easy to apply, and internal validation has shown a PPV of 100%.
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Affiliation(s)
- J López
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011 of Instituto de Salud Carlos III, Complutense University of Madrid, Spain. C/ Dr Castelo 47, 28009, Madrid, Spain.
| | - C Sánchez
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011 of Instituto de Salud Carlos III, Complutense University of Madrid, Spain. C/ Dr Castelo 47, 28009, Madrid, Spain
- Pediatric Gastroenterology Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011 of Instituto de Salud Carlos III, Complutense University of Madrid, Madrid, Spain
| | - S N Fernández
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011 of Instituto de Salud Carlos III, Complutense University of Madrid, Spain. C/ Dr Castelo 47, 28009, Madrid, Spain
| | - R González
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011 of Instituto de Salud Carlos III, Complutense University of Madrid, Spain. C/ Dr Castelo 47, 28009, Madrid, Spain
| | - M J Solana
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011 of Instituto de Salud Carlos III, Complutense University of Madrid, Spain. C/ Dr Castelo 47, 28009, Madrid, Spain
| | - J Urbano
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011 of Instituto de Salud Carlos III, Complutense University of Madrid, Spain. C/ Dr Castelo 47, 28009, Madrid, Spain
| | - J López-Herce
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011 of Instituto de Salud Carlos III, Complutense University of Madrid, Spain. C/ Dr Castelo 47, 28009, Madrid, Spain.
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López J, Barba MG, Fernández SN, Solana MJ, Urbano J, Sánchez C, López-Herce J. Protocol for treatment of constipation with polyethylene glycol 3350 plus electrolytes in critically ill children. An Pediatr (Barc) 2023; 99:176-184. [PMID: 37640660 DOI: 10.1016/j.anpede.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/02/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES No studies have analysed the effectiveness of treatment for constipation in critically ill children. The aim of this study was to assess the implementation, efficacy and safety of a treatment protocol using polyethylene glycol 3350 with electrolytes (PEG 3350 + E) for constipation in critically ill children. METHODS We conducted a single-centre prospective study in children admitted to the paediatric intensive care unit for a minimum of 72 h and who developed constipation. Children with previous gastrointestinal disorders or diseases were excluded. The patients were treated with rectal enemas or with the oral PEG 3350 + E protocol at the discretion of the treating physician. We compared clinical and demographic variables as well as adverse events (diarrhoea, abdominal distension and electrolyte imbalances). RESULTS The sample included 56 patients with a mean age of 48.2 ± 11.9 months, of who 55.4% were male. Forty-four patients (78.6%) were treated with PEG 3350 + E and 12 (21.4%) with rectal enemas. The proportion of patients that responded well to treatment was greater in the PEG 3350 + E group (79.5%) compared to the enema group (58.3%), but the difference was not statistically significant (P = .151). There were no significant differences between the groups in any of the adverse effects. Treatment with PEG 3350 + E was more effective in children aged less than 2 years (100%) compared to older children (100% vs 65.4%; P < .01), with no significant differences in the development of adverse events. CONCLUSIONS The PEG 3350 + E treatment protocol for constipation in critically ill children was effective and associated with few adverse events, even in children aged less than 2 years.
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Affiliation(s)
- Jorge López
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network, Redes de Investigación Cooperativa Orientadas a Resultados en Salud [RICORS]) (RD21/0012/0011), Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain.
| | - María G Barba
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Montepríncipe, Madrid, Spain
| | - Sarah N Fernández
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network, Redes de Investigación Cooperativa Orientadas a Resultados en Salud [RICORS]) (RD21/0012/0011), Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain
| | - María J Solana
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network, Redes de Investigación Cooperativa Orientadas a Resultados en Salud [RICORS]) (RD21/0012/0011), Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Urbano
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network, Redes de Investigación Cooperativa Orientadas a Resultados en Salud [RICORS]) (RD21/0012/0011), Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain
| | - César Sánchez
- Unidad de Gastroenterología Infantil, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, RICORS (RD21/0012/0011), Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain
| | - Jesús López-Herce
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network, Redes de Investigación Cooperativa Orientadas a Resultados en Salud [RICORS]) (RD21/0012/0011), Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain
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11
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Park YG, Kim BS, Kang KT, Ha YC. Effects of Abdominal Massage for Preventing Acute Postoperative Constipation in Hip Fractures: A Prospective Interventional Study. Clin Orthop Surg 2023; 15:546-551. [PMID: 37529190 PMCID: PMC10375809 DOI: 10.4055/cios22091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 08/03/2023] Open
Abstract
Background This prospective randomized controlled study aimed to determine the effects of abdominal massage on constipation management in elderly patients with hip fractures. Methods From August 2017 to December 2018, patients aged above 65 years with hip fractures (n = 88) were randomly assigned to a massage group that received a bowel massage (n = 48) or a control group that did not receive a bowel massage (n = 40). Patients in the bowel massage group received a bowel massage from a trained caregiver after breakfast at approximately 9:00 AM for an hour. On admission, 5 days after surgery, and on the day of discharge, the patient's normal and actual defecation pattern, stool consistency, and any problems with defecation were assessed through a structured interview. The questionnaire comprising the Bristol Stool Scale, patient assessment of constipation, time to defecation, medication for defecations, failure to defecate, cause of admission, admission period, and date of surgery were recorded. Statistical analyses were performed 5 days after surgery and on the day of discharge. Results The mean age of the study cohort was 81.4 years (range, 65-99 years). The number of constipation remedies was significantly lower in the massage group than in the control group on postoperative day (POD) 5 and at discharge (9 vs. 15, p = 0.049 and 6 vs. 11, p = 0.039, respectively). The number of defecation failures was significantly lower in the massage group than in the control group (10 vs. 17, p = 0.028) on POD 5. However, the number of defecation failures at discharge was not significantly different between the two groups (p = 0.131). The development of postoperative ileus (p = 0.271) and length of hospital stay (p = 0.576) were not different between the groups. Conclusions The number of constipation remedies was significantly lower in the massage group than in the control group on POD 5 and discharge, and the number of defecation failures was significantly lower in the massage group than in the control group on POD 5. Therefore, abdominal massage may be considered as an independent nursing initiative for constipation management.
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Affiliation(s)
- Yong-Gum Park
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Korea
| | - Boo Seop Kim
- Department of Orthopedic Surgery, Chung-Ang University H.C.S. Hyundae General Hospital, Namyangju, Korea
| | - Kyu-Tae Kang
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopedic Surgery, Seoul Bumin Hospital, Seoul, Korea
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12
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Kaye AJ, Atkin S, Ziobro A, Donnelly J, Ahlawat S. Analysis of the economic burden of docusate sodium at a United States tertiary care center. Hosp Pract (1995) 2023; 51:168-173. [PMID: 37334679 DOI: 10.1080/21548331.2023.2225964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/13/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES The primary objective was to determine the financial resources allocated to docusate at a representative U.S. tertiary care center. Secondary objectives included comparing docusate utilization between two tertiary care centers, and exploring alternative uses for the funds spent on docusate. METHODS The study population included all patients 18 years and older admitted to University Hospital in Newark, New Jersey. Every scheduled docusate prescription for the study population between January 1st, 2015 and December 31st, 2019 was collected. The annual total cost associated with docusate use per year was calculated. The 2015 data from this study and a 2015 McGill University Health Centre study were compared. Also, alternative uses for the money utilized on docusate were assessed. RESULTS Over the study period, 37,034 docusate prescriptions and 265,123 docusate doses were recorded. The average cost of prescribing docusate was $25,624.14 per year and $49.37 per hospital bed per year. A comparison between the 2015 data of University Hospital and McGill showed that McGill prescribed 107 doses and spent $10.09 more per hospital bed than University Hospital. Finally, alternative uses for the average yearly spending on docusate equated to 0.35 the salary of a nurse, 0.51 the salary of a secretary, 20.66 colonoscopies, 27.00 upper endoscopies, 186.71 mammograms, 1,399.37 doses of polyethylene glycol 3350, 3,826.57 doses of lactulose, or 4,583.80 doses of psyllium. CONCLUSION A single average size tertiary care hospital spent about $25,000 yearly on docusate despite its lack of clinical effectiveness. While this amount is small compared to an overall hospital budget, when considering likely comparable docusate use at the U.S's 6,090 hospitals, the economic burden of docusate becomes significant. The funds currently being used on docusate could be redirected to alternative, more cost-effective purposes.
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Affiliation(s)
- Alexander J Kaye
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Suzanne Atkin
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Aidan Ziobro
- Pharmacy Department, University Hospital, Newark, NJ, USA
| | - Jason Donnelly
- Pharmacy Department, University Hospital, Newark, NJ, USA
| | - Sushil Ahlawat
- Division of Gastroenterology and Hepatology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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13
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Rizwan MZ, Garcia R, Mara K, Nei S. Evaluating the Safety and Efficacy of Naloxegol in Critically Ill Opioid-Induced Constipation Patients. Cureus 2023; 15:e41422. [PMID: 37546147 PMCID: PMC10403335 DOI: 10.7759/cureus.41422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background Opioid-induced constipation (OIC) has become more common in the intensive care unit (ICU) due to increased opioid utilization. Traditional laxatives often prove ineffective against OIC, leading to the increased utilization of naloxegol. However, further research is needed to confirm naloxegol's effectiveness and safety in critical care. This study aimed to explore the safety and efficacy of this intervention in critically ill OIC patients. Methods A single-center retrospective study was conducted on 353 patients who received one or more doses of naloxegol from January 1, 2019, to June 30, 2020, for OIC at a tertiary care center. The primary endpoint of this study was to evaluate serious adverse events such as reduced analgesic effect, gastrointestinal perforation, seizure, acute myocardial infarction (AMI), or ventricular arrhythmias using Naranjo Scale in critically ill patients. The secondary goal was to assess the efficacy of naloxegol, measured by the time of the first bowel movement. Results The average duration of naloxegol use was three days, with the first bowel movement occurring at an average of 11.3 hours. Furthermore, 59.8% of individuals had their first bowel movement within 20 hours of receiving naloxegol. There was a low level of causality between naloxegol use and adverse events such as gastrointestinal perforation, seizures, AMI, cardiovascular mortality, stroke, and ventricular arrhythmia. Additionally, reduction in analgesia showed no strong relationship with naloxegol use indicated by the Naranjo Scale assessment. Conclusion Naloxegol showed promising safety and efficacy profiles in treating OIC amongst critically ill patients, though our findings require further validation through prospective studies. This research paves the way for further investigation into naloxegol's role in OIC management, emphasizing the necessity of personalized treatment strategies in critical care settings.
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Affiliation(s)
| | | | - Kristin Mara
- Department of Biostatistics, Mayo Clinic, Rochester, USA
| | - Scott Nei
- Department of Pharmacy, Mayo Clinic, Rochester, USA
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14
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Wang L, Gharibani P, Yang Y, Guo Y, Yin J. Regulation of enteric nervous system via sacral nerve stimulation in opioid-induced constipated rats. Front Neurosci 2023; 17:1146883. [PMID: 37332864 PMCID: PMC10272359 DOI: 10.3389/fnins.2023.1146883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Objectives Sacral nerve stimulation (SNS) has been employed for treating constipation. However, its mechanisms involving enteric nervous system (ENS) and motility are largely unknown. In this study, we investigated the possible ENS involvement of SNS in treating Loperamide-induced constipation in rats. Methods Experiment-1 was designed to study the effects of acute SNS on whole colon transit time (CTT). In experiment-2, we induced constipation by Loperamide and then applied daily SNS or sham-SNS for 1 week. Choline acetyltransferase (ChAT), nitric oxide synthase (nNOS), and PGP9.5 in colon tissue were examined at the end of the study. Moreover, survival factors such as phosphorylated AKT (p-AKT) and Glial cell-derived neurotrophic factor (GDNF) were measures by immunohistochemistry (IHC) and western blot (WB). Key results (1) SNS with one set of parameters shortened CTT starting at 90 min after phenol red administration (p < 0.05). (2) While Loperamide induced slow transit constipation with a significant reduction in fecal pellet number and feces wet weight, daily SNS for a week resolved constipation. (3) Moreover, SNS was able to shorten whole gut transit time comparing to sham-SNS (p = 0.01). (4) Loperamide reduced the number of PGP9.5 and ChAT positive cells, and downregulated ChAT protein expression and upregulated nNOS protein expression, whereas these detrimental effects were significantly reversed by SNS. (5) Furthermore, SNS increased expressions of both GDNF and p-AKT in colon tissue. (6) Vagal activity was reduced following Loperamide (p < 0.01); yet SNS normalized vagal activity. Conclusion SNS with appropriate parameters improves opioid-induced constipation and reversed the detrimental effects of Loperamide on enteric neurons possibly via the GDNF-PI3K/Akt pathway.GRAPHICAL ABSTRACT.
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Affiliation(s)
- Liyun Wang
- Department of Gastroenterology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Payam Gharibani
- Division of Neuroimmunology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Yi Yang
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Gastroenterology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yu Guo
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jieyun Yin
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Farchadi D, Slatkin NE, Stambler N, Israel RJ, Matus M. Cumulative Laxation Response with Methylnaltrexone: Implications for Hospitalized Patients with Advanced Illness and Opioid-Induced Constipation. CURRENT THERAPEUTIC RESEARCH 2023; 98:100694. [PMID: 36875317 PMCID: PMC9981808 DOI: 10.1016/j.curtheres.2023.100694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 01/23/2023] [Indexed: 01/30/2023]
Abstract
Background Opioid-induced constipation (OIC) may increase the risk of fecal impaction and mortality in patients with advanced illness. Methylnaltrexone (MNTX) is efficacious for OIC. Objective The purpose of this analysis was to evaluate cumulative rescue-free laxation response with repeat MNTX dosing in patients with advanced illness who were refractory to current laxative regimens and to assess the influence, if any, of poor functional status on response to MNTX treatment. Methods This analysis included pooled data from patients with advanced illness and established OIC who were on a stable opioid regimen in a pivotal, randomized, placebo (PBO)-controlled clinical trial (study 302 [NCT00402038]) or a randomized, PBO-controlled Food and Drug Administration-required postmarketing study (study 4000 [NCT00672477]). Patients in study 302 received subcutaneous MNTX 0.15 mg/kg or PBO every other day, whereas those in study 4000 received MNTX 8 mg (body weight ≥38 to <62 kg), MNTX 12 mg (body weight ≥62 kg), or PBO every other day. Outcomes included cumulative rescue-free laxation rates at 4- and 24-hours postdose for the first 3 doses of study drug and time to rescue-free laxation. To assess if functional status influenced treatment outcomes, we performed a secondary analysis on the outcomes stratified by baseline World Health Organization/Eastern Cooperative Oncology Group performance status, pain scores, and safety. Results One hundred eighty-five patients received PBO and 179 patients received MNTX. The median age was 66.0 years, 51.5% were women, 56.5% had a baseline World Health Organization/Eastern Cooperative Oncology Group performance status score >2, and 63.4% had a primary diagnosis of cancer. Cumulative rescue-free laxation rates were significantly higher with MNTX than PBO 4- and 24-hours after doses 1, 2, and 3 (P < 0.0001), and between-treatment comparisons remained significant (P < 0.0001) regardless of performance status. The estimated time to first rescue-free laxation was shorter for patients receiving MNTX versus PBO. No new safety signals were identified. Conclusions Repeated use of MNTX represents a safe and effective treatment for OIC in patients with advanced illness regardless of baseline performance status. ClinicalTrials.gov identifier: NCT00672477. (Curr Ther Res Clin Exp. 2023; 84:XXX-XXX)© 2023 Elsevier HS Journals, Inc.
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Affiliation(s)
- David Farchadi
- Loma Linda University Medical Center, Loma Linda, California
| | - Neal E Slatkin
- School of Medicine, University of California Riverside, Riverside, California.,Salix Pharmaceuticals, Bridgewater, New Jersey
| | - Nancy Stambler
- Progenics Pharmaceuticals, Inc, a subsidiary of Lantheus Holdings, Inc, Clinical Research, New York, New York
| | | | - Michael Matus
- Loma Linda University Medical Center, Loma Linda, California
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Habeeb EA, Tran LK, Goodberlet MZ, Lupi KE, DeGrado JR, Dube KM. Naloxone Versus Methylnaltrexone for Opioid-Induced Constipation in Critically Ill Patients. Ann Pharmacother 2022:10600280221132851. [DOI: 10.1177/10600280221132851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Opioid-induced constipation (OIC) may occur in up to 81% of critically ill patients and can lead to many complications. Opioid antagonists are a reasonable approach and may be used for managing OIC. Objective: The purpose of this study was to assess the efficacy of enteral naloxone (NLX) versus subcutaneous methylnaltrexone (MNTX) for the management of OIC in critically ill patients. Methods: A retrospective analysis was conducted on adult patients who received NLX or MNTX and a continuous opioid infusion for at least 48 hours. The primary end point was time to resolution of constipation, defined as hours to first bowel movement (BM) after the first dose of an opioid antagonist. Reversal of analgesia was assessed by comparing the total number of morphine milligram equivalents (MME) 24 hours preopioid and postopioid antagonist administration. Univariate and multivariate analyses were conducted to assess treatment response within 48 hours. Results: Baseline characteristics were similar between patients receiving NTX (n = 89) and MNTX (n = 71). However, the time to the first BM with NLX was 18 hours compared with 41 hours with MNTX ( P = 0.004). There was no difference in MME requirements 24 hours pre/post NLX or MNTX administration. Naloxone administration was identified as a statistically significant predictor of BM within 48 hours (odds ratio [OR] = 2.68 [1.33-5.38]). Conclusion and Relevance: The time to first BM was shorter with enteral NLX. Both NLX and MNTX appear to be effective for the management of OIC without causing reversal of analgesia. Future controlled, prospective trials comparing these agents are warranted.
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Affiliation(s)
- Ehsan A. Habeeb
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Clinical Pharmacy, College of Pharmacy, Taibah University, Madinah, Kingdom of Saudi Arabia
| | - Lena K. Tran
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Kenneth E. Lupi
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jeremy R. DeGrado
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA, USA
| | - Kevin M. Dube
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA, USA
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Gastrointestinal Dysmotility in Critically Ill Patients: Bridging the Gap Between Evidence and Common Misconceptions. J Clin Gastroenterol 2022; 57:440-450. [PMID: 36227004 DOI: 10.1097/mcg.0000000000001772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Disruption of normal gastrointestinal (GI) function in critical illness is linked to increased morbidity and mortality, and GI dysmotility is frequently observed in patients who are critically ill. Despite its high prevalence, the diagnosis and management of GI motility problems in the intensive care unit remain very challenging, given that critically ill patients often cannot verbalize symptoms and the general lack of understanding of underlying pathophysiology. Common clinical presentations of GI dysmotility issues among critically ill patients include: (1) high gastric residual volumes, acid reflux, and vomiting, (2) abdominal distention, and (3) diarrhea. In this review, we discuss the differential diagnosis for intensive care unit patients with symptoms and signs concerning GI motility issues. There are many myths and longstanding misconceptions about the diagnosis and management of GI dysmotility in critical illness. Here, we uncover these myths and discuss relevant evidence in each subject area, with the goal of re-conceptualizing GI motility disorders in critical care and providing evidence-based recommendations for clinical care.
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Alves de Paula J, Rabito EI, Justino SR, Leite LS, Dantas D, Makiyama da Silva JS, Maffini LF, Júnior OR. Administration of enteral nutrition and gastrointestinal complications in Covid-19 critical patients in prone position. CLINICAL NUTRITION OPEN SCIENCE 2022; 45:80-90. [PMID: 36059438 PMCID: PMC9420200 DOI: 10.1016/j.nutos.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/20/2022] [Indexed: 12/15/2022] Open
Abstract
Background The prone position (PP) used in the treatment of critically ill patients infected with SARS-CoV-2, may be a barrier to enteral nutrition (EN). This study aimed to analyze the effectiveness and complications of EN in the PP, as well as clinical outcomes. Methods Prospective cohort study with patients in EN and coronavirus disease 2019 (COVID-19), on mechanical ventilation (MV), which whom needed or not PP. Gastrointestinal intolerances (GII) related to PP were evaluated, and correlated with possible confounding factors. EN, days on MV, Intensive Care Unit (ICU) length of stay, hospital length of stay, ventilator-associated pneumonia (VAP) and mortality were analyzed. The data were evaluated daily and compared prone group (PG=57) and supine group (SG=69). Results The PP was associated with GII (P=0.000) and presented in 32 patients (26,44%) with no difference among groups. Association between epinephrine (P=0.003), vasopressin (P=0.018), and GII was observed. There was no difference between the total volume of enteral nutrition (TVEN) infused in the groups. However, the mean EN infused for the days when the patient was on PP was (70.0% ± 31.5) and for the days in supine position was (74.8% ± 27.3), P= 0.006. The PG had a longer time on MV (P=0.005) and ICU (P=0.003) and PP was associated with VAP (P=<0.001). The infused TVEN showed no association with VAP (P=0.09). Conclusion PP was a determining factor in GII and proved to be a risk factor for VAP, but the EN protocol seems to have ensured an adequate EN supply in PP and be a safe alternative.
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Affiliation(s)
- Jéssica Alves de Paula
- Clinical Nutrition Unit, Clinical Hospital Complex - Federal University of Paraná, Curitiba-PR, Brazil
| | | | - Sandra Regina Justino
- Nutrition Department of the Brazilian Association of Intensive Care Medicine, São Paulo-SP, Brazil
- Nutrition Department of the Intensive Care Society of Paraná Brazil, Curitiba-PR, Brazil
| | - Luíza Silva Leite
- Clinical Nutrition Unit, Clinical Hospital Complex - Federal University of Paraná, Curitiba-PR, Brazil
| | - Danielle Dantas
- Clinical Nutrition Unit, Clinical Hospital Complex - Federal University of Paraná, Curitiba-PR, Brazil
| | | | - Larissa Farinha Maffini
- Clinical Nutrition Unit, Clinical Hospital Complex - Federal University of Paraná, Curitiba-PR, Brazil
| | - Odery Ramos Júnior
- Department of Internal Medicine, Gastroenterology Division, Clinical Hospital Complex - Federal University of Paraná, Curitiba-PR, Brazil
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19
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Tharanon V, Putthipokin K, Sakthong P. Drug-related problems identified during pharmaceutical care interventions in an intensive care unit at a tertiary university hospital. SAGE Open Med 2022; 10:20503121221090881. [PMID: 35465635 PMCID: PMC9021480 DOI: 10.1177/20503121221090881] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/11/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Drug-related problems could potentially worsen the clinical outcomes in critically ill patients. Critically ill patients are generally considered more vulnerable to harm from drug-related problems due to frequent medication-related events and complicated clinical courses. However, drug-related problems identified by on-ward clinical pharmacists in medical intensive care units in Thailand are not well reported. This study reports clinically relevant data with the description of identified problems, common causes of drug-related problems, and pharmacists’ interventions performed in real world, so that it may serve as an educational material for pharmacists who implement a pharmaceutical care and participate in medical intensive care units. Methods: A retrospective descriptive study was conducted at a tertiary university hospital in Bangkok, Thailand, from January 2015 to December 2020. The drug-related problems were categorized according to Cipolle et al.’s classification. The severity of drug-related problems in this study was rated by modifying the definition of The National Coordinating Council for Medication Error Reporting and Prevention Taxonomy of Medication Error to report harm from drug-related problem-related patient outcomes. Results: A total of 698 drug-related problems were detected in 374 critically ill patients. The prevalence of drug-related problems occurring in critically ill patients admitted to the medical intensive care unit was 73.9%. The most frequent drug-related problems were dosage too high (27.7%), ineffective drug (17.2%), need for additional drug therapy (15.3%), unnecessary drug therapy (14.6%), dosage too low (14.3%), adverse drug reaction (9.7%), and non-adherence (1.2%). The severity of drug-related problems in the medical intensive care unit was assessed as a drug-related problem with no harm (78.2%). Pharmacists’ interventions were advised according to drug-related problem identification to provide personalized pharmacotherapy optimization in critically ill patients. Conclusion: The most frequent drug-related problem identified during pharmaceutical care interventions in the medical intensive care unit at tertiary university hospital is dosage too high. The severity of drug-related problems is mostly determined as drug-related problems with no harm.
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Affiliation(s)
- Vichapat Tharanon
- Clinical Pharmacy Section, Pharmacy Division, Ramathibodi Hospital, Bangkok, Thailand
| | - Krongtong Putthipokin
- Clinical Pharmacy Section, Pharmacy Division, Ramathibodi Hospital, Bangkok, Thailand
| | - Phantipa Sakthong
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
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20
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A systematic review of the definitions and prevalence of feeding intolerance in critically ill adults. Clin Nutr ESPEN 2022; 49:92-102. [DOI: 10.1016/j.clnesp.2022.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 12/12/2022]
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Naloxegol to Prevent Constipation in ICU Adults Receiving Opioids: A Randomized Double-Blind Placebo-Controlled Pilot Trial. Crit Care Res Pract 2022; 2022:7541378. [PMID: 35356796 PMCID: PMC8958087 DOI: 10.1155/2022/7541378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background Constipation is frequent in critically ill adults receiving opioids. Naloxegol (N), a peripherally acting mu-receptor antagonist (PAMORA), may reduce constipation. The objective of this trial was to evaluate the efficacy and safety of N to prevent constipation in ICU adults receiving opioids. Methods and Patients. In this single-center, double-blind, randomized trial, adults admitted to a medical ICU receiving IV opioids (≥100 mcg fentanyl/day), and not having any of 17 exclusion criteria, were randomized to N (25 mg) or placebo (P) daily randomized to receive N (25mg) or placebo (P) and docusate 100 mg twice daily until ICU discharge, 10 days, or diarrhea (≥3 spontaneous bowel movement (SBM)/24 hours) or a serious adverse event related to study medication. A 4-step laxative protocol was initiated when there was no SBM ≥3 days. Results Only 318 (20.6%) of the 1542 screened adults during the 1/17–10/19 enrolment period met all inclusion criteria. Of these, only 19/381 (4.9%) met all eligibility criteria. After 7 consent refusals, 12 patients were randomized. The study was stopped early due to enrolment futility. The N (n = 6) and P (n = 6) groups were similar. The time to first SBM (N 41.4 ± 31.7 vs. P 32.5 ± 25.4 hours, P = 0.56) was similar. The maximal daily abdominal pressure was significantly lower in the N group (N 10 ± 4 vs. P 13 ± 5, P = 0.002). The median (IQR) daily SOFA scores were higher in N (N 7 (4, 8) vs. P 4 (3, 5), P < 0.001). Laxative protocol use was similar (N 83.3% vs. P 66.6%; P = 0.51). Diarrhea prevalence was high but similar (N 66.6% vs. P 66.6%; P = 1.0). No patient experienced opioid withdrawal. Conclusions Important recruitment challenges exist for ICU trials evaluating the use of PAMORAs for constipation prevention. Despite being underpowered, our results suggest time to first SBM with naloxegol, if different than P, may be small. The effect of naloxegol on abdominal pressure, SOFA, and the interaction between the two requires further research.
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Yan Y, Lei C, Su B, Dong E, Wang G, Li B, Li X, Li A, Gan G, Chen Y, Zhang X. Effects of Nalbuphine on Gastrointestinal Function in Post-Operative Critical Ill Patients Admitted to the ICU: A Multicenter Randomized Controlled Trial. Front Med (Lausanne) 2022; 9:836872. [PMID: 35252270 PMCID: PMC8888859 DOI: 10.3389/fmed.2022.836872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Gastrointestinal (GI) function can be a significant problem in critically ill patients and is associated with detrimental outcomes. The administration of opioids for pain reduction is thought to contribute to GI dysfunction. We tested whether nalbuphine, a mixed agonist/antagonist opioid modulator, can promote GI recovery in postoperative critical patients admitted to the intensive care unit (ICU) and compared it with fentanyl, a selective mu opioid receptor (MOR) agonist. Methods This is a multicenter, single-blind, randomized controlled trial to investigate whether nalbuphine improves the GI recovery in ICU patients after surgery, and compared it with fentanyl. The primary outcome was the time to first defecation. Secondary outcomes included the use of sedatives, enemas or laxatives, the acute gastrointestinal injury (AGI) grade, the incidence of vomiting, and the lengths of ICU and hospital stays. Results We randomized 436 patients, and a total of 369 patients were included in the modified intention-to-treat population (mITT) (185 to the nalbuphine group and 184 to the fentanyl group). The baseline demographic characteristics of the two groups were comparable after randomization. There was no significant difference in the time to defecation between the two groups [hazard ratio (HR) 0.94, 95% CI 0.74–1.19, p = 0.62]. There was no significant difference in the secondary outcomes between the two groups. Conclusion We found no evidence that nalbuphine administration can improve the GI function in postoperative critical patients admitted to the ICU compared with fentanyl. However, the CI was wide and we could not exclude the clinically important difference.
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Affiliation(s)
- Yun Yan
- Department of Intensive Care Unit, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Chong Lei
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Binxiao Su
- Department of Intensive Care Unit, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Enxia Dong
- Department of Intensive Care Unit, The Affiliated Honghui Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Guangming Wang
- Department of Intensive Care Unit, Hospital of NORINCO GROUP, Xi'an, China
| | - Bin Li
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
| | - Xinyu Li
- Department of Intensive Care Unit, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Aiguang Li
- Department of Intensive Care Unit, Aerospace General Hospital, Xi'an, China
| | - Guifen Gan
- Department of Intensive Care Unit, Qinghai University Affiliated Hospital, Xining, China
| | - Yu Chen
- Department of Intensive Care Unit, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Xijing Zhang
- Department of Intensive Care Unit, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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McClave SA. Nutrition, defecation, and the lower gastrointestinal tract during critical illness. Curr Opin Clin Nutr Metab Care 2022; 25:110-115. [PMID: 35026804 DOI: 10.1097/mco.0000000000000814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The goal of this report is to delineate the correlation between constipation as a manifestation of impaired gastrointestinal transit with adverse clinical outcomes, to identify risk factors, which predispose to this condition, and outline a management scheme for prophylactic treatment. RECENT FINDINGS Constipation is common in the ICU, affecting upwards of 60-85% of critically ill patients. As suggested by case series and observational studies, constipation may be an independent prognostic factor identifying patients with greater disease severity, higher likelihood of organ dysfunction, longer duration of mechanical ventilation, prolonged hospital length of stay, and possibly reduced survival. Treating constipation is a low priority for intensivists often relegated to the nursing service, and few ICUs have well designed protocols in place for a bowel regimen. Small randomized controlled trials show improvement in certain outcome parameters in response to a daily lactulose therapy; hospital length of stay, sequential organ failure assessment scores, and duration of mechanical ventilation. However, aggregating the data from these studies in two separate meta-analyses showed that the effect of a bowel regimen on these three endpoints were not statistically different. SUMMARY No causal relationship can be determined between constipation and adverse outcomes. Nonetheless, a clinical correlation seems to exist. Whether constipation is an epiphenomenon or simply a reflection of greater severity of critical illness, at some point it may contribute to worsening morbidity in the ICU. A graded prophylactic bowel regimen should help reverse impairment of the gastrointestinal transit and aid in reducing its deleterious impact on the hospital course of the critically ill patient.
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Affiliation(s)
- Stephen A McClave
- Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, Kentucky, USA
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Yoshida T, Uchino S, Sasabuchi Y. Epidemiology of constipation in critically ill patients and its impact on in-hospital mortality: a retrospective observational study. J Anesth 2022; 36:349-358. [PMID: 35190868 DOI: 10.1007/s00540-022-03050-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/10/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE There are several causes for delayed constipation in critically ill patients. Constipation in critically ill patients is reportedly associated with poor outcomes. However, a consistent definition for constipation and reports on the prognosis of critically ill patients with constipation are lacking. Therefore, we aimed to determine the epidemiology of constipation during critical illness, and assess the association between constipation and in-hospital mortality based on the two definitions of constipation used in previous studies. METHODS This retrospective cohort study comprised adult patients in a general intensive care unit (ICU) during 2011-2018. We retrieved the information regarding their bowel movements and assessed the impact of constipation on the in-hospital mortality based on the previous definitions (absence of defecation for 72 and 144 h). RESULTS Among the 1933 adult ICU patients included, the proportion of patients with constipation decreased with a longer duration of constipation (72 h: 67%, 144 h: 36%). In-hospital mortality in the constipation group was much lower than that in the non-constipation group in the univariable analysis (72 h, 27% vs. 13%; 144 h, 31% vs. 21%). However, constipation was not associated with in-hospital mortality in the multivariable analysis (adjusted odds ratio: 0.91, 95% confidence interval: 0.64-1.30 and adjusted odds ratio: 1.14, 95% confidence interval: 0.70-1.85 at 72 and 144 h, respectively). CONCLUSIONS Constipation in critically ill patients was not associated with in-hospital mortality based on any definition of constipation used in previous studies. Further prospective studies are necessary to validate our findings.
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Affiliation(s)
- Takuo Yoshida
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, 3-19-18, Nishi-Shinbashi Minato-ku, Tokyo, Japan. .,Department of Intensive Care Medicine, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan.
| | - Shigehiko Uchino
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, 3-19-18, Nishi-Shinbashi Minato-ku, Tokyo, Japan.,Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Centre, 1-847 Amanuma, Omiya-ku, Saitama, Saitama, Japan
| | - Yusuke Sasabuchi
- Data Science Center, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, Japan
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25
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Ali H, Pamarthy R, Manickam S, Sarfraz S, Sahebazamani M, Movahed H. Effect of constipation on outcomes in mechanically ventilated patients. Proc AMIA Symp 2022; 35:284-290. [DOI: 10.1080/08998280.2022.2035153] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Hassam Ali
- Department of Internal Medicine, East Carolina University/Vidant Medical Center, Greenville, North Carolina
| | - Rahul Pamarthy
- Department of Internal Medicine, East Carolina University/Vidant Medical Center, Greenville, North Carolina
| | - Swethaa Manickam
- Department of Internal Medicine, East Carolina University/Vidant Medical Center, Greenville, North Carolina
| | - Shiza Sarfraz
- Department of Internal Medicine, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Mitra Sahebazamani
- Department of Pulmonology and Critical Care, East Carolina University/Vidant Medical Center, Greenville, North Carolina
| | - Hossein Movahed
- Department of Gastroenterology, East Carolina University/Vidant Medical Center, Greenville, North Carolina
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26
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Asrani VM, McArthur C, Bissett I, Windsor JA. The intensivist's assessment of gastrointestinal function: A pilot study. Aust Crit Care 2021; 35:636-643. [PMID: 34895985 DOI: 10.1016/j.aucc.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/30/2022] Open
Abstract
Gastrointestinal dysfunction/failure (GDF) is a common cause of concern in critically ill patients. Although the gut plays an important role in the genesis of organ failure, its exclusion from organ severity scoring systems has made it challenging for intensivists to score it sufficiently at the bedside. We aimed to survey intensive care specialists about their perceptions, attitudes, and approaches towards the assessment of the gut in Australia and New Zealand intensive care units (ICUs). An electronic (online) questionnaire was used to survey intensive care specialists from the Australia and New Zealand Intensive Care Society (ANZICS). The survey comprised 10 questions focused on four key areas: (i) the extent of the problem with GDF in ICUs, (ii) the use and reliability of the current gut scoring tools, (iii) personal approaches and practices associated with GDF assessment, and (4) potential value of a novel GDF scoring system and its incorporation into an organ severity score. Our results showed that GDF was a significant concern amongst ICUs in Australia and New Zealand intensivists (84%; 66/79), with a small number of participants (14%; 3/79) using a gut scoring tool in their ICUs. Despite this, we have no established objective scoring tool for its assessment. The survey highlighted the need for developing a novel scoring tool to assess the gut was considered important amongst majority of the intensivists (92%; 72/78), which would prove useful in clinical practice and potentially lead to incorporation into an organ severity score in the future.
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Affiliation(s)
- Varsha M Asrani
- Surgical and Translational Research (STaR) Centre, Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Nutrition and Dietetics, Auckland City Hospital, Auckland, New Zealand; Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand.
| | - Colin McArthur
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Ian Bissett
- Surgical and Translational Research (STaR) Centre, Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of General Surgery, Auckland City Hospital, Auckland, New Zealand
| | - John A Windsor
- Surgical and Translational Research (STaR) Centre, Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of General Surgery, Auckland City Hospital, Auckland, New Zealand
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Satoh K, Nakae H. Daijokito Administration in Critically Ill Patients Increasing the Stool Volume: A Retrospective Observational Study. Front Nutr 2021; 8:749570. [PMID: 34708065 PMCID: PMC8542686 DOI: 10.3389/fnut.2021.749570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Daijokito, a traditional Japanese herbal medicine (Kampo), has been used to treat abdominal distention of the middle yang stage pattern. The use of Daijokito has not been thoroughly investigated in critical care. To investigate a new Kampo approach to defecation control in critically ill patients, our study aimed to assess the effects of Daijokito on fecal management. Methods: We analyzed 30 consecutive patients treated with Daijokito in the intensive care unit (ICU) between March 2017 and February 2021. The eligibility criteria were patients who were newly prescribed Daijokito in the ICU during the study period. Exclusion criteria were patients who were started on other laxatives within one day of beginning Daijokito. The study's primary outcome was defecation volume three days before and three days after starting Daijokito. We recorded the most dominant stool quality within three days after the start of Daijokito. Results: Twenty-one patients were included in the analysis. The median age was 69.0 years, and the median sequential organ failure assessment score on admission to the ICU was 6.0. Major diseases included trauma, pancreatitis, and burns. Administration of Daijokito resulted in defecation in 17 of twenty-one patients (81.0%). Comparison of defecation volume between 3 days before Daijokito administration and three days, including the day of Daijokito administration, showed that defecation volume increased significantly after Daijokito administration, with a median of 0 to 360 g (p < 0.001). At the three-day follow-up, six of 17 (35.3%) patients defecated on the day of Daijokito administration, and nine (52.9%) defecated on the day after administration. One patient was judged to have excessive defecation, and Daijokito administration was discontinued. Stool quality was normal in one (5.9%) of the 17 patients, soft-formed in two (11.8%), loose-unformed in 11 (64.7%), and liquid in three (17.6%). Discussion: Daijokito administration in critically ill patients caused defecation in 81% of the patients and significantly increased stool volume. The novelty of this study is that it sheds light on the Kampo treatment of defecation control in critically ill patients. In addition to the present report, further studies are warranted to quantify the therapeutic efficacy and safety of Daijokito.
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Affiliation(s)
- Kasumi Satoh
- Advanced Emergency and Critical Care Center, Akita University Hospital, Akita, Japan
| | - Hajime Nakae
- Advanced Emergency and Critical Care Center, Akita University Hospital, Akita, Japan
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28
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Yan Y, Chen Y, Zhang X. The effect of opioids on gastrointestinal function in the ICU. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:370. [PMID: 34689805 PMCID: PMC8543814 DOI: 10.1186/s13054-021-03793-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/12/2021] [Indexed: 12/31/2022]
Abstract
Gastrointestinal (GI) dysfunction is common in the critical care setting and is highly associated with clinical outcomes. Opioids increase the risk for GI dysfunction and are frequently prescribed to reduce pain in critically ill patients. However, the role of opioids in GI function remains uncertain in the ICU. This review aims to describe the effect of opioids on GI motility, their potential risk of increasing infection and the treatment of GI dysmotility with opioid antagonists in the ICU setting.
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Affiliation(s)
- Yun Yan
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.,Department of Critical Care Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Yu Chen
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China. .,Department of Critical Care Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
| | - Xijing Zhang
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China. .,Department of Critical Care Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
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Khandker SS, Kabir A, Hasan MJ, Ahmed MS, Gan SH, Khalil MI, Islam MA, Hossan T, Kamal MA. Elachi Lemon (Citrus limon) Peel and Pulp: Antioxidant, Antimicrobial, Anticoagulant Activities, Bioactive Compounds, Minerals, and Heavy Metals. CURRENT BIOACTIVE COMPOUNDS 2021. [DOI: 10.2174/1573407215999201005164239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background:
According to a number of previous studies, citrus fruits are rich in phytochemicals,
minerals and bioactive compounds.
Objective:
The aim of this study was to investigate the antioxidant, antimicrobial and anticoagulant
activities, phytonutrients, bioactive compounds, mineral and heavy metals in the peel and pulp of
Elachi lemon (Citrus limon).
Methods:
Phytochemical screening was performed to estimate the total polyphenol, flavonoid, tannin,
reducing sugar, total protein and vitamin C contents. High performance liquid chromatography
was performed to determine the concentrations of phenolics and ascorbic acid. Antioxidant activities
were evaluated by measuring 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging activity,
reducing power assay and ferric reducing antioxidant power (FRAP) assay. Antibacterial activity
was evaluated by the disc diffusion method and minimum inhibitory concentration (MIC).
Besides estimating heavy metals and minerals, activated partial thromboplastin time (aPTT) and
prothrombin time (PT) were observed for detecting anticoagulant activity.
Results:
In the case of antioxidant and antimicrobial activities, the pulp was found to be richer.
Both the peel and pulp showed similar anticoagulant activities. Among the phytonutrients, protein
content was richer in the peel than in the pulp. Catechin, rutin, tannic, gallic and vanillic acids were
detected in the peel, whereas in pulp quercetin, tannic and gallic acids were found. Pb, Cr, Cd were
present in a negligible amount whereas, Co, Cu and Fe were high in both the peel and the pulp.
Conclusion:
This study exhibits that both the peel and the pulp of Citrus limon are a rich source of
antioxidant, antimicrobial, anticoagulant, minerals and various bioactive compounds with nutritional
values.
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Affiliation(s)
- Shahad Saif Khandker
- Laboratory of Preventive and Integrative Biomedicine, Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
| | - Alamgir Kabir
- Laboratory of Preventive and Integrative Biomedicine, Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
| | - Md. Jahid Hasan
- Cell Genetics and Plant Biotechnology Lab, Department of Biotechnology & Genetic Engineering, Jahangirnagar University, Savar, Dhaka-1342, Bangladesh
| | - Md. Shohael Ahmed
- Cell Genetics and Plant Biotechnology Lab, Department of Biotechnology & Genetic Engineering, Jahangirnagar University, Savar, Dhaka-1342, Bangladesh
| | - Siew Hua Gan
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia
| | - Md. Ibrahim Khalil
- Laboratory of Preventive and Integrative Biomedicine, Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
| | - Md Asiful Islam
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Tareq Hossan
- Laboratory of Preventive and Integrative Biomedicine, Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
| | - Mohammad Amjad Kamal
- West China School of Nursing / Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
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30
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Altun Ugras G, Yüksel S, Isik MT, Tasdelen B, Dogan H, Mutluay O. Effect of abdominal massage on bowel evacuation in neurosurgical intensive care patients. Nurs Crit Care 2020; 27:558-566. [PMID: 33179847 DOI: 10.1111/nicc.12575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are many factors, which affect the bowel evacuation of neurosurgical intensive care unit (NICU) patients, resulting in constipation. AIM AND OBJECTIVES The aim of this study was to investigate effect of abdominal massage on bowel evacuation and the risk of constipation in NICU patients. DESIGN A prospective, randomized-controlled clinical trial. METHODS The sample of this study included 80 NICU patients. The patients were randomly assigned to abdominal massage and control groups. The constipation risk of all the patients was assessed with Constipation Risk Assessment Scale (CRAS). The patients in the abdominal massage group received a total of 30 minutes of massage, 15 minutes every morning and evening, until the first defecation. The bowel sounds of all patients in the abdominal massage and control groups were assessed on a daily basis. The days when bowel sounds were heard and the first defecation took place were recorded in a Bowel Evacuation Form. RESULTS The risk of constipation was higher in the patients in the abdominal massage (CRAS score 19.02 ± 1.81) and control groups (CRAS score 20.45 ± 2.61). The time of return of bowel sounds and the time of the first defecation were earlier in the abdominal massage group, compared to the control group (P < .05). In the control group, there was a weak correlation (P = .004) between the CRAS score and the time of return of bowel sounds, while there was a moderate correlation between the CRAS score and the time of the first defecation (P < .001). CONCLUSION Our study results show that the risk of constipation is high in NICU patients, and abdominal massage is an effective nursing intervention to shorten the time of return of bowel sounds and the time of the first defecation. RELEVANCE TO CLINICAL PRACTICE Nurses can safely apply abdominal massage to improve bowel evacuation in NICU patients.
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Affiliation(s)
- Gulay Altun Ugras
- Nursing Faculty, Department of Surgical Nursing, Mersin University, Mersin, Turkey
| | - Serpil Yüksel
- Nursing Faculty, Department of Surgical Nursing, Necmettin Erbakan University, Konya, Turkey
| | - Meryem Turkan Isik
- Nursing Faculty, Department of Fundamentals Nursing, Mersin University, Mersin, Turkey
| | - Bahar Tasdelen
- Department of Biostatistics and Medical Informatics, Mersin University Medical Faculty, Mersin, Turkey
| | - Havva Dogan
- Surgery Intensive Care Unit, Mersin University Hospital, Mersin, Turkey
| | - Ozum Mutluay
- Surgery Intensive Care Unit, Mersin University Hospital, Mersin, Turkey
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31
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Chang H, Li S, Li Y, Hu H, Cheng B, Miao J, Gao H, Ma H, Gao Y, Wang Q. Effect of sedation with dexmedetomidine or propofol on gastrointestinal motility in lipopolysaccharide-induced endotoxemic mice. BMC Anesthesiol 2020; 20:227. [PMID: 32894042 PMCID: PMC7487735 DOI: 10.1186/s12871-020-01146-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022] Open
Abstract
Background Sepsis often accompanies gastrointestinal motility disorder that contributes to the development of sepsis in turn. Propofol and dexmedetomidine, as widely used sedatives in patients with sepsis, are likely to depress gastrointestinal peristalsis. We queried whether propofol or dexmedetomidine, at sedative doses, aggravated sepsis-induced ileus. Methods Sedative/Anesthetic Scores and vital signs of lipopolysaccharide (LPS)-induced endotoxemic mice were measured during sedation with propofol or dexmedetomidine. Endotoxemic mice were divided into 10% fat emulsion, propofol, saline, and dexmedetomidine group. The gastric emptying, small intestinal transit, tests of colonic motility, gastrointestinal transit and whole gut transit were evaluated at 15 mins and 24 h after intraperitoneal injection of sedatives/vehicles respectively. Results 40 mg·kg− 1propofol and 80 μg·kg− 1 dexmedetomidine induced a similar depth of sedation with comparable vital signs except that dexmedetomidine strikingly decreased heart rate in endotoxemic mice. Dexmedetomidine markedly inhibited gastric emptying (P = 0.006), small intestinal transit (P = 0.006), colonic transit (P = 0.0006), gastrointestinal transit (P = 0.0001) and the whole gut transit (P = 0.034) compared with the vehicle, whereas propofol showed no depression on all parts of gastrointestinal motility 15 mins after administration. The inhibitive effects of dexmedetomidine in these tests vanished 24 h after the administration. Conclusions Deep sedation with dexmedetomidine, but not propofol, significantly inhibited gastrointestinal peristalsis in endotoxemic mice while the inhibitory effect disappeared 24 h after sedation. These data suggested that both propofol and dexmedetomidine could be applied in septic patients while dexmedetomidine should be used cautiously in patients with cardiac disease or ileus.
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Affiliation(s)
- Haiqing Chang
- Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Shuang Li
- Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Yansong Li
- Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Hao Hu
- Department of Pharmacology, School of Basic Medical Sciences, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Bo Cheng
- Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Jiwen Miao
- Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Hui Gao
- Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Hongli Ma
- Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Yanfeng Gao
- Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| | - Qiang Wang
- Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
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Hajji N, Wannes D, Jabri MA, Rtibi K, Tounsi H, Abdellaoui A, Sebai H. Purgative/laxative actions of Globularia alypum aqueous extract on gastrointestinal-physiological function and against loperamide-induced constipation coupled to oxidative stress and inflammation in rats. Neurogastroenterol Motil 2020; 32:e13858. [PMID: 32337785 DOI: 10.1111/nmo.13858] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/24/2020] [Accepted: 03/28/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Chronic constipation is a gastrointestinal functional disorder which affects patient quality of life. Therefore, many studies were oriented to search herbal laxative agents. In this study, we investigated the effect of Globularia alypum L. leaves aqueous extract (GAAE) against loperamide (LOP)-produced constipation. METHODS Animals were given LOP (3 mg/kg, b.w., i.p.) and GAAE (100, 200, and 400 mg/kg, b.w., p.o.) or yohimbine (2 mg/kg, b.w., i.p.), simultaneously, for 1 week. Gastric-emptying test and intestinal transit were determined. Colon histology was examined, and oxidative status was evaluated using biochemical-colorimetric methods. KEY RESULTS GAAE ameliorates significantly gastric emptying (64% to 76.5%) and intestinal transit (66.65% to 84.73%). LOP negatively influenced defecation parameters and generated a stress situation. GAAE administration in contrast ameliorated those parameters and re-established oxidative balance. CONCLUSION GAAE showed a modest action against oxidative stress and decreased LOP effect and thereby can be considered a pharmacological agent in constipation.
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Affiliation(s)
- Najla Hajji
- Laboratoire de Physiologie Fonctionnelle et Valorisation des Bio-Ressources, Institut Supérieur de Biotechnologie de Béja, Université de Jendouba, Béja, Tunisia
| | - Dalanda Wannes
- Laboratoire de Physiologie Fonctionnelle et Valorisation des Bio-Ressources, Institut Supérieur de Biotechnologie de Béja, Université de Jendouba, Béja, Tunisia
| | - Mohamed-Amine Jabri
- Laboratoire de Physiologie Fonctionnelle et Valorisation des Bio-Ressources, Institut Supérieur de Biotechnologie de Béja, Université de Jendouba, Béja, Tunisia
| | - Kais Rtibi
- Laboratoire de Physiologie Fonctionnelle et Valorisation des Bio-Ressources, Institut Supérieur de Biotechnologie de Béja, Université de Jendouba, Béja, Tunisia
| | - Haifa Tounsi
- Laboratoire d'anatomie Pathologique Humaine et Expérimentalse, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Afifa Abdellaoui
- Laboratoire d'anatomie Pathologique Humaine et Expérimentalse, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Hichem Sebai
- Laboratoire de Physiologie Fonctionnelle et Valorisation des Bio-Ressources, Institut Supérieur de Biotechnologie de Béja, Université de Jendouba, Béja, Tunisia
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Abbasalizadeh S, Ebrahimi B, Azizi A, Dargahi R, Tayebali M, Ghadim ST, Foroumandi E, Aliasghari F, Javadi M, Izadi A, Banifatemeh L, Pourjafar H, Khalili L, Ghalichi F, Houshmandi S, Rad AH. Review of Constipation Treatment Methods with Emphasis on Laxative Foods. CURRENT NUTRITION & FOOD SCIENCE 2020. [DOI: 10.2174/1573401315666191002164336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Constipation is a common public health concern experienced by all individuals during
their life affecting the quality of life. In this paper, we aimed to provide an overview of the existing
evidence regarding the role of food ingredients, including bran, prune, fig, kiwifruit, and flax-seed in
constipation treatment. We searched Scopus, Pub Med, and Science Direct by using the keywords,
“laxative foods” and “constipation”, for searching studies assessing laxative food ingredients and
their beneficial effects on constipation treatment and/or control. Lifestyle modifications such as increasing
dietary fiber and fluid intake and daily exercise are the proposed first line treatments for
constipation. Optimizing ‘diet’ as an efficient lifestyle factor may contribute to the well-being of patients.
The use of laxative food ingredients including bran, prune, fig, kiwifruit, flax-seed, probiotics,
and prebiotics is a convenient alternative to cope with constipation. According to previous findings,
laxative food ingredients could be considered as effective treatments for subjects suffering from constipation.
Many studies have assessed the pharmacological and non-pharmacological roles of these
ingredients in treating constipation, however, their importance has not been thoroughly investigated.
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Affiliation(s)
- Shamsi Abbasalizadeh
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behzad Ebrahimi
- Department of Food Science and Technology, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Aslan Azizi
- Agricultural Engineering Research Institute, Ministry of Jihad Agriculture, Karaj, Iran
| | - Rogaye Dargahi
- Obstetrics and Gynecology, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Maryam Tayebali
- Department of Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | - Sepideh T. Ghadim
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elaheh Foroumandi
- Nutrition Research Center, School of Nutrition, Tabriz University of Medical Science, Tabriz, Iran
| | - Fereshteh Aliasghari
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mina Javadi
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azimeh Izadi
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Banifatemeh
- Department of Food Science & Technology, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Pourjafar
- Department of Public Health, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Leila Khalili
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Faezeh Ghalichi
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sousan Houshmandi
- Faculty of Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Aziz H. Rad
- Department of Food Science & Technology, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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Launey Y, Painvin B, Roquilly A, Dahyot-Fizelier C, Lasocki S, Rousseau C, Frasca D, Gacouin A, Seguin P. Factors associated with time to defecate and outcomes in critically ill patients: a prospective, multicentre, observational study. Anaesthesia 2020; 76:218-224. [PMID: 32662524 DOI: 10.1111/anae.15178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2020] [Indexed: 12/20/2022]
Abstract
Delayed defecation is common in patients on intensive care. We aimed to determine factors associated with time to defecation after admission to intensive care and in turn its association with length of stay and mortality. We studied 396 adults admitted to one of five intensive care units in whom at least 2 days' invasive ventilation was anticipated during an expected stay of at least 3 days. The median (IQR [range]) time to defecate by the 336 out of 396 (84%) patients who did so before intensive care discharge was 6 (4-8 [1-18]) days. Defecation was independently associated with five factors, hazard ratio (95%CI), higher values indicating more rapid defecation: alcoholism, 1.32 (1.05-1.66), p = 0.02; laxatives before admission, 2.35 (1.79-3.07), p < 0.001; non-invasive ventilation, 0.54 (0.36-0.82), p = 0.004; duration of ventilation, 0.78 (0.74-0.82), p < 0.001; laxatives after admission, 1.67 (1.23-2.26), p < 0.001; and enteral nutrition within 48 h of admission, 1.43 (1.07-1.90), p = 0.01. Delayed defecation was associated with prolonged intensive care stay but not mortality.
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Affiliation(s)
- Y Launey
- Department of Anaesthesia and Critical Care, University Hospital, Rennes, France
| | - B Painvin
- Department of Anaesthesia and Critical Care, University Hospital, Rennes, France
| | - A Roquilly
- Department of Anaesthesia and Critical Care, University Hospital, Nantes, France
| | - C Dahyot-Fizelier
- Department of Anaesthesia and Critical Care, University Hospital, Poitiers, France
| | - S Lasocki
- Department of Anaesthesia and Critical Care, University Hospital, Angers, France
| | - C Rousseau
- Department of Clinical Investigation, University Hospital, Rennes, France
| | - D Frasca
- Department of Anaesthesia and Critical Care, University Hospital, Poitiers, France
| | - A Gacouin
- Medical Intensive Care and Infectious Diseases, University Hospital, Rennes, France
| | - P Seguin
- Department of Anaesthesia and Critical Care, University Hospital, Rennes, France
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Charlesworth M, Ashworth AD. The evolution of evidence-based medicine in critical care: have we left 'time to defecation' behind? Anaesthesia 2020; 76:161-164. [PMID: 32662063 DOI: 10.1111/anae.15183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2020] [Indexed: 01/16/2023]
Affiliation(s)
- M Charlesworth
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester, UK
| | - A D Ashworth
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester, UK
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Abstract
Bowel dysfunction, especially ileus, has been increasingly recognized in critically ill patients. Ileus is commonly associated to constipation, however abnormal motility can also concern the upper digestive tract, therefore impaired gastrointestinal transit (IGT) seems to be a more appropriate term. IGT, especially constipation, is common among patients under mechanical ventilation, occurring in up to 80% of the patients during the first week, and has been associated with worse outcome in intensive care unit (ICU). It is acknowledged that the most relevant definition for constipation in ICU is the absence of stool for the first six days after admission. Concerning the upper digestive intolerance (UDI), the diagnosis should rely only on vomiting and the systematic gastric residual volume (GRV) monitoring should be avoided. IGT results from a complex pathophysiology in which both the critical illness and its specific treatments may have a deleterious role. Both observational and experimental studies have shown the deleterious effect of sepsis, multiorgan failure, sedation (especially opioids) and mechanical ventilation on gut function. To date few studies have reported effect of treatment on IGT and the level of evidence is low. However, cholinesterase inhibitors seem safe and could probably be used in case of constipation but remains poorly prescribed. Prevention with bowel management protocol using osmotic laxatives appears to be safe but did not demonstrate its effectiveness. For patients treated with high posology of opioids during sedation, enteral opioid antagonists may be a promising strategy.
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Affiliation(s)
- Philippe Ariès
- Clermont-Tonnerre Military Teaching Hospital, Brest, France.,Val-de-Grâce French Military Health Service Academy, Paris, France.,Department of Anesthesia and Surgical Intensive Care, Brest Teaching Hospital, Brest, France
| | - Olivier Huet
- Department of Anesthesia and Surgical Intensive Care, Brest Teaching Hospital, Brest, France - .,UFR of Medicine, University of Western Brittany, Brest, France
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Oh KN, Kim Y, Choi EJ, Lee H, Hong JA, Kim M, Oh DR, Jung MA, Park RD, Kim SI, Yong JS, Lee HS, Ban S, Choi CY. Laxative Activity of the Hot-Water Extract Mixture of Hovenia dulcis Thunb. and Phyllostachys pubescens Mazel in Chronic Constipation Model SD Rats. J Microbiol Biotechnol 2020; 30:649-661. [PMID: 32482930 PMCID: PMC9728358 DOI: 10.4014/jmb.1911.11051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/18/2020] [Indexed: 12/15/2022]
Abstract
This study examined the laxative effects of hot-water extracts of Hovenia dulcis Thunb. (HD), Phyllostachys pubescens Mazel (PM), and a 2:8 mixture of both (HP) in two chronic constipation models. For the loperamide-induced constipation model, animals were divided into an untreated group, negative control group (loperamide 4 mg/kg), positive control group (bisacodyl 4 mg/kg) group, and six treatment groups (HP 100 or 400, HD 50 or 100, and PM 100 or 400 mg/kg). For the lowfiber diet-induced constipation model, animals were divided into an untreated group (normal diet), negative control group (low-fiber diet), positive control group (Agio granule, 620 mg/kg), and the same treatment groups. Fecal number, weight, fecal water content, and intestinal transit ratio were higher in the groups treated with HP, HD, and PM than in the groups treated with loperamide or lowfiber diet. Thickness of colon mucosa and muscle layers were increased in the treated groups. Colon tension increased in the HP groups, and [Ca2+]i measurements using fura-2 as an indicator showed that HP inhibits ATP-mediated Ca2+ influx in IEC-18 cells. These results showed that the HP mixture has laxative activity by increased mucin secretion and inducing contractile activity and relaxation. It may be a useful therapeutic strategy for ameliorating in chronic constipation.
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Affiliation(s)
- Kyo-Nyeo Oh
- Jeonnam Bioindustry Foundation, Jeonnam Institute of Natural Resources Research, Jangheung-gun 59338, Republic of Korea
| | - Yujin Kim
- Jeonnam Bioindustry Foundation, Jeonnam Institute of Natural Resources Research, Jangheung-gun 59338, Republic of Korea
| | - Eun Jin Choi
- Jeonnam Bioindustry Foundation, Jeonnam Institute of Natural Resources Research, Jangheung-gun 59338, Republic of Korea
| | - Hyunmi Lee
- Jeonnam Bioindustry Foundation, Jeonnam Institute of Natural Resources Research, Jangheung-gun 59338, Republic of Korea
| | - Ji Ae Hong
- Jeonnam Bioindustry Foundation, Jeonnam Institute of Natural Resources Research, Jangheung-gun 59338, Republic of Korea
| | - Miri Kim
- Jeonnam Bioindustry Foundation, Jeonnam Institute of Natural Resources Research, Jangheung-gun 59338, Republic of Korea
| | - Dool-Ri Oh
- Jeonnam Bioindustry Foundation, Jeonnam Institute of Natural Resources Research, Jangheung-gun 59338, Republic of Korea
| | - Myung-A Jung
- Jeonnam Bioindustry Foundation, Jeonnam Institute of Natural Resources Research, Jangheung-gun 59338, Republic of Korea
| | - Ro-Dong Park
- Agroceuticals Lab, Haenam Natural Farming Association Corporation, Gwangju 61111, Republic of Korea
| | - Seong-Il Kim
- Agroceuticals Lab, Haenam Natural Farming Association Corporation, Gwangju 61111, Republic of Korea
| | - Ju-Seon Yong
- Agroceuticals Lab, Haenam Natural Farming Association Corporation, Gwangju 61111, Republic of Korea
| | - Hui-Seop Lee
- Agroceuticals Lab, Haenam Natural Farming Association Corporation, Gwangju 61111, Republic of Korea
| | - SangOh Ban
- Jeonnam Bioindustry Foundation, Jeonnam Institute of Natural Resources Research, Jangheung-gun 59338, Republic of Korea
| | - Chul-Yung Choi
- Jeonnam Bioindustry Foundation, Jeonnam Institute of Natural Resources Research, Jangheung-gun 59338, Republic of Korea
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Laxative Effects of Yangyin Tongmi Capsule on a Model of Diphenoxylate-Induced Constipation in Mice. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:1471824. [PMID: 32148532 PMCID: PMC7056994 DOI: 10.1155/2020/1471824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/31/2019] [Accepted: 01/29/2020] [Indexed: 12/30/2022]
Abstract
Constipation is characterized by reduced number of bowel movements, dry stools, and difficult defecation. Yangyin Tongmi capsule (YTC), a traditional Chinese formula, is used in the treatment of constipation, while the underlying mechanisms remain unknown. Herein, this work attempted to prove the effects of YTC on constipation treatment and its possible mechanisms. KM mice were randomly divided into four groups (n = 10/group) and treated with double distilled water (Control), diphenoxylate (Model: 10 mg/kg), or diphenoxylate plus low-dose YTC (L-YTC: 0.6 g/kg) or high-dose YTC (H-YTC: 1.2 g/kg). The data indicated that YTC can significantly shorten the discharge time of the first black stool, improve intestinal propulsion rate, and increase the water content and quantity of feces in mice. ELISA suggested that YTC regulate the content of intestinal hormones and neurotransmitters, such as motilin (MTL), gastrin (GT), somatostatin (SST), substance P (SP), acetylcholine (Ach), and nitric oxide (NO). The expression levels of aquaporin 3 (AQP3) and aquaporin 8 (AQP8) in the colon were examined by immunohistochemistry. In the meantime, the expression levels of P2X2, C-kit, and stem cell factor (SCF) in the colon were examined by western blot analysis. The results of this study suggest that YTC has mitigative effects on diphenoxylate-induced constipation by regulating the content of intestinal hormones and neurotransmitters and regulating the expression of related proteins in the colon.
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Methylnaltrexone for the treatment of opioid-induced constipation and gastrointestinal stasis in intensive care patients. Results from the MOTION trial. Intensive Care Med 2020; 46:747-755. [PMID: 32016532 PMCID: PMC7223905 DOI: 10.1007/s00134-019-05913-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/23/2019] [Indexed: 02/07/2023]
Abstract
Purpose Constipation can be a significant problem in critically unwell patients, associated with detrimental outcomes. Opioids are thought to contribute to the mechanism of bowel dysfunction. We tested if methylnaltrexone, a pure peripheral mu-opioid receptor antagonist, could reverse opioid-induced constipation. Methods The MOTION trial is a multi-centre, double blind, randomised placebo-controlled trial to investigate whether methylnaltrexone alleviates opioid-induced constipation (OIC) in critical care patients. Eligibility criteria included adult ICU patients who were mechanically ventilated, receiving opioids and were constipated (had not opened bowels for a minimum 48 h) despite prior administration of regular laxatives as per local bowel management protocol. The primary outcome was time to significant rescue-free laxation. Secondary outcomes included gastric residual volume, tolerance of enteral feeds, requirement for rescue laxatives, requirement for prokinetics, average number of bowel movements per day, escalation of opioid dose due to antagonism/reversal of analgesia, incidence of ventilator-associated pneumonia, incidence of diarrhoea and Clostridium difficile infection and finally 28 day, ICU and hospital mortality. Results A total of 84 patients were enrolled and randomized (41 to methylnaltrexone and 43 to placebo). The baseline demographic characteristics of the two groups were generally well balanced. There was no significant difference in time to rescue-free laxation between the groups (Hazard ratio 1.42, 95% CI 0.82–2.46, p = 0.22). There were no significant differences in the majority of secondary outcomes, particularly days 1–3. However, during days 4–28, there were fewer median number of bowel movements per day in the methylnaltrexone group, (p = 0.01) and a greater incidence of diarrhoea in the placebo group (p = 0.02). There was a marked difference in mortality between the groups, with ten deaths in the methylnaltrexone group and two in the placebo group during days 4–28 (p = 0.007). Conclusion We found no evidence to support the addition of methylnaltrexone to regular laxatives for the treatment of opioid-induced constipation in critically ill patients; however, the confidence interval was wide and a clinically important difference cannot be excluded. Electronic supplementary material The online version of this article (10.1007/s00134-019-05913-6) contains supplementary material, which is available to authorized users.
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Murali M, Ly C, Tirlapur N, Montgomery HE, Cooper JA, Wilson AP. Diarrhoea in critical care is rarely infective in origin, associated with increased length of stay and higher mortality. J Intensive Care Soc 2020; 21:72-78. [PMID: 32284721 PMCID: PMC7137165 DOI: 10.1177/1751143719843423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Diarrhoea, defined as > 3 loose or liquid stools per day, affects 9.7-41% of intensive care unit patients, negatively impacting on patient dignity, intensifying nursing workload and increasing morbidity. Its pathogenesis is poorly understood, but infective agents, intensive care unit therapies (such as enteral feed) and critical illness changes in the gut microbiome are thought to play a role. We analysed a consecutive cohort of 3737 patients admitted to a mixed general intensive care unit. Diarrhoea prevalence was lower than previously reported (5.3%), rarely infective in origin (6.5%) and associated with increased length of stay (median (inter-quartile range) 2.3 (1.0-5.0) days vs. 10 days (5.0-22.0), p < 0.001, sub-distribution hazard ratio 0.55 (95% CI 0.48-0.63), p < 0.001) and mortality (9.5% vs. 18.1%, p = 0.005, sub-distribution hazard ratio 1.20 (95% CI 0.79-1.81), p = 0.40), compared to patients without diarrhoea. In addition, 17.1% of patients received laxatives <24 h prior to diarrhoea onset. Further research on diarrhoea's pathogenesis in critical care is required; robust treatment protocols, investigation rationalisation and improved laxative prescribing may reduce its incidence and improve related outcomes.
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Affiliation(s)
- Mayur Murali
- Anaesthetic Department, Whittington Hospital, London, UK
| | - Clare Ly
- Department of Intensive Care, Whittington Hospital, London, UK
| | - Nikhil Tirlapur
- Section of Anaesthetics, Pain Medicine & Intensive Care, Faculty of Medicine, Imperial College London, London, UK
| | - Hugh E Montgomery
- Centre for Human Health and Performance, University College London, London, UK
| | - Jackie A Cooper
- Institute of Cardiovascular Science, University College London, London, UK
| | - A Peter Wilson
- Department of Microbiology & Virology, University College London Hospitals, London, UK
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The Manufacturing Process of Kiwifruit Fruit Powder with High Dietary Fiber and Its Laxative Effect. Molecules 2019; 24:molecules24213813. [PMID: 31652679 PMCID: PMC6864858 DOI: 10.3390/molecules24213813] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/09/2019] [Accepted: 10/20/2019] [Indexed: 12/14/2022] Open
Abstract
Kiwifruit is rich in vitamins, minerals, dietary fiber and other functional components, and it has long been used as a functional food to treat intestinal ailments such as constipation. The current research made full use of the kiwifruit, the juice was prepared by microencapsulation, and the dietary fiber in kiwifruit pomace was modified by enzymatic hydrolysis and grinding, then, the two were mixed to obtain an ultra-micro kiwifruit powder (UKP). In addition, the laxative effect of the UKP was verified by a diphenoxylate induced constipated mice model. The results demonstrated that compared with the raw samples, the retention rate of vitamin C, lutein and catechin in UKP were 83.3%, 81.9% and 88.3%, respectively, thus effectively avoiding the loss of functional components during the processing of kiwifruit. Moreover, α-amylase, protease and the ball milling process effectively reduced the size of dietary fiber in kiwifruit pomace, and its water-holding capacity (WHC), oil-holding capacity (OHC) and swelling capacity (SWC) were enhanced by 1.26, 1.65 and 1.10 times, respectively. Furthermore, to analyze the laxative effect of the UKP, a constipation mice model was established by diphenoxylate treatment (5 mg·kg−1, i.g.) for the last week, with or without UKP supplementation (2.4 g·kg−1 B.W. per day) for 4 weeks. The results demonstrated that UKP significantly increased feces condition (fecal output and dejecta moisture content, gut transit (the intestinal propulsion rates) and substance P (SP) levels in portal vein plasma, and it decreased the whole gut transit time and mucinogen granules secreted by goblet cell in constipated mice.
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Chen Z, Lin S, Jiang Y, Liu L, Jiang J, Chen S, Tong Y, Wang P. Effects of Bread Yeast Cell Wall Beta-Glucans on Mice with Loperamide-Induced Constipation. J Med Food 2019; 22:1009-1021. [DOI: 10.1089/jmf.2019.4407] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Zhuoyi Chen
- College of Pharmacy, Zhejiang University of Technology, Hangzhou, China
| | - SuSu Lin
- College of Pharmacy, Zhejiang University of Technology, Hangzhou, China
| | - Yu Jiang
- College of Pharmacy, Zhejiang University of Technology, Hangzhou, China
| | - Ling Liu
- College of Pharmacy, Zhejiang University of Technology, Hangzhou, China
| | - Jinyan Jiang
- College of Pharmacy, Zhejiang University of Technology, Hangzhou, China
| | - Shuting Chen
- College of Pharmacy, Zhejiang University of Technology, Hangzhou, China
| | - Yingpeng Tong
- College of Life Sciences, Taizhou University, Taizhou, China
| | - Ping Wang
- College of Pharmacy, Zhejiang University of Technology, Hangzhou, China
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Hay T, Deane AM, Rechnitzer T, Fetterplace K, Reilly R, Ankravs M, Bailey M, Fazio T, Anstey J, D’Costa R, Presneill JJ, MacIsaac CM, Bellomo R. The hospital-based evaluation of laxative prophylaxis in ICU (HELP-ICU): A pilot cluster-crossover randomized clinical trial. J Crit Care 2019; 52:86-91. [DOI: 10.1016/j.jcrc.2019.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 12/19/2022]
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Lim JM, Kim YD, Song CH, Park SJ, Park DC, Cho HR, Jung GW, Bashir KMI, Ku SK, Choi JS. Laxative effects of triple fermented barley extracts (FBe) on loperamide (LP)-induced constipation in rats. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:143. [PMID: 31226979 PMCID: PMC6587300 DOI: 10.1186/s12906-019-2557-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 06/11/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Constipation, a common health problem, causes discomfort and affects the quality of life. This study intended to evaluate the potential laxative effect of triple fermented barley (Hordeum vulgare L.) extract (FBe), produced by saccharification, Saccharomyces cerevisiae, and Weissella cibaria, on loperamide (LP)-induced constipation in Sprague-Dawley (SD) rats, a well-established animal model of spastic constipation. METHODS Spastic constipation was induced via oral treatment with LP (3 mg/kg) for 6 days 1 h before the administration of each test compound. Similarly, FBe (100, 200 and 300 mg/kg) was orally administered to rats once a day for 6 days. The changes in number, weight, and water content of fecal, motility ratio, colonic mucosa histology, and fecal mucous contents were recorded. The laxative properties of FBe were compared with those of a cathartic stimulant, sodium picosulfate. A total of 48 (8 rats in 6 groups) healthy male rats were selected and following 10 days of acclimatization. Fecal pellets were collected one day before administration of the first dose and starting from immediately after the fourth administration for a duration of 24 h. Charcoal transfer was conducted after the sixth and final administration of the test compounds. RESULTS In the present study, oral administration of 100-300 mg/kg of FBe exhibited promising laxative properties including intestinal charcoal transit ratio, thicknesses and mucous producing goblet cells of colonic mucosa with decreases of fecal pellet numbers and mean diameters remained in the lumen of colon, mediated by increases in gastrointestinal motility. CONCLUSION Therefore, FBe might act as a promising laxative agent and functional food ingredient to cure spastic constipation, with less toxicity observed at a dose of 100 mg/kg.
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Affiliation(s)
- Jong-Min Lim
- Glucan Corp, #305 Marine Bio-Industry Development Center, Hoenggye-ri 27, Ilgwang-myeon, Gijan-gun Busan, 46048 Republic of Korea
| | - Young Dae Kim
- South East Sea Fisheries Research Institute, National Institute of Fisheries Sciences, Tongyoung-si, Gyeongsangnam-do 53085 Republic of Korea
| | - Chang-Hyun Song
- Department of Anatomy and Histology, College of Korean Medicine, Daegu Haany University, 290 Yugok-dong, Gyeongsan-si, Gyeongsanbuk-do 38610 Republic of Korea
- MRC-GHF, College of Korean Medicine, Daegu Haany University, 290 Yugok-dong, Gyeongsan-si, Gyeongsanbuk-do 38610 Republic of Korea
| | - Su-Jin Park
- Department of Anatomy and Histology, College of Korean Medicine, Daegu Haany University, 290 Yugok-dong, Gyeongsan-si, Gyeongsanbuk-do 38610 Republic of Korea
- MRC-GHF, College of Korean Medicine, Daegu Haany University, 290 Yugok-dong, Gyeongsan-si, Gyeongsanbuk-do 38610 Republic of Korea
| | - Dong-Chan Park
- Glucan Corp, #305 Marine Bio-Industry Development Center, Hoenggye-ri 27, Ilgwang-myeon, Gijan-gun Busan, 46048 Republic of Korea
| | - Hyung-Rae Cho
- Glucan Corp, #305 Marine Bio-Industry Development Center, Hoenggye-ri 27, Ilgwang-myeon, Gijan-gun Busan, 46048 Republic of Korea
| | - Go-Woon Jung
- Glucan Corp, #305 Marine Bio-Industry Development Center, Hoenggye-ri 27, Ilgwang-myeon, Gijan-gun Busan, 46048 Republic of Korea
| | - Khawaja Muhammad Imran Bashir
- German Engineering Research and Development Center for Life Science Technologies in Medicine and Environment, 31, Gwahaksandan 1-ro, 60 beon-gil, Gangseo-gu, Busan, 46742 Republic of Korea
- Seafood Research Center, IACF, Silla University, 606, Advanced Seafood Processing Complex, Wonyang-ro, Amnam-dong, Seo-gu Busan, 49277 Republic of Korea
| | - Sae Kwang Ku
- Department of Anatomy and Histology, College of Korean Medicine, Daegu Haany University, 290 Yugok-dong, Gyeongsan-si, Gyeongsanbuk-do 38610 Republic of Korea
| | - Jae-Suk Choi
- Division of Bioindustry, College of Medical and Life Sciences, Silla University, 140 Baegyang-daero, 700 beon-gil, Sasang-gu Busan, 46958 Republic of Korea
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Abstract
PURPOSE OF REVIEW Gastrointestinal dysmotility occurs frequently in the critically ill. Although the causes underlying dysmotility are multifactorial, both pain and its treatment with exogenous opioids are likely causative factors. The purpose of this review is to describe the effects of pain and opioids on gastrointestinal motility; outline the rationale for and evidence supporting the administration of opioid antagonists to improve dysmotility; and describe the potential influence opioids drugs have on the intestinal microbiome and infectious complications. RECENT FINDINGS Opioid drugs are frequently prescribed in the critically ill to alleviate pain. In health, opioids cause gastric dysmotility, yet the evidence for this in critical illness is inconsistent and limited to observational studies. Administration of opioid antagonists may improve gastrointestinal motility, but data are sparse, and these agents cannot be recommended outside of clinical trials. Although critical illness is associated with alterations in the microbiome, the extent to which opioid administration influences these changes, and the subsequent development of infection, remains uncertain. SUMMARY Replication of clinical studies from ambulant populations in critical care is required to ascertain the independent influence of opioid administration on gastrointestinal motility and infectious complications.
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Evaluation of gastric motility through surface electrogastrography in critically ill septic patients. Comparison of metoclopramide and domperidone effects: A pilot randomized clinical trial. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2019. [DOI: 10.1016/j.rgmxen.2018.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Alikiaii B, Majedi MA, Hashemi ST, Kiani M. Comparing the Efficacy of Two Drugs Senalin and Bisacodyl in Treatment of Constipation in Intensive Care Units' Patients. Adv Biomed Res 2019; 8:17. [PMID: 30993087 PMCID: PMC6425743 DOI: 10.4103/abr.abr_165_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Constipation is an intestinal syndrome that can be created alone or in the context of another disease in patients admitted to intensive care units (ICUs). Given the role of sennosides in increasing the transfer rate of materials from the large intestine, we aimed to compare the effect of senalin with bisacodyl on the treatment of constipation in patients admitted to ICUs. Materials and Methods In this randomized, double-blind study, 70 patients admitted to the ICU were divided into two groups. The senalin recipient group received senalin with a dose of 500 mg daily for 3 days. The bisacodyl recipient group received bisacodyl with a dose of 10 mg daily for 3 days. Results The mean of defecation frequency during the 2nd day of treatment of constipation was significantly higher in the group receiving bisacodyl than in the senalin group (P < 0.01). There was no significant difference between the two groups in terms of fecal consistency in any of the study days (P < 0.05). The prevalence of complications in the 3rd day of treatment was significantly higher in bisacodyl group than in the senalin group (P = 0.04). Conclusion Given the lack of difference in the efficacy of two drugs, fecal consistency, daily defecation frequency and fewer complications of senalin compared to bisacodyl, it s eems that this drug can be used as an appropriate treatment for constipation in patients admitted to ICUs.
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Affiliation(s)
- Babak Alikiaii
- Department of Anesthesia and Critical Care, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Azad Majedi
- Department of Anesthesiology, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Seyed Taghi Hashemi
- Department of Anesthesia and Critical Care, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Kiani
- Department of Anesthesia and Critical Care, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Heinonen T, Ferrie S, Ferguson C. Gut function in the intensive care unit - What is 'normal'? Aust Crit Care 2019; 33:151-154. [PMID: 30745063 DOI: 10.1016/j.aucc.2018.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 12/15/2018] [Accepted: 12/28/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Management of gut function in the intensive care unit (ICU) is often protocol-driven. Protocols for enteral feeding or bowel management are based on assumptions about what is 'normal' gastrointestinal motility during critical illness or in the early postoperative period, although 'normal' has not been well described in this group. OBJECTIVES This study aimed to describe aspects of gut function based on an audit of current ICU patients. METHODS A retrospective medical audit of 100 recent consecutive ICU patients was conducted to obtain data on gut function parameters in the critically ill or postoperative population. RESULTS The audit indicated that delayed gastric emptying is common in the ICU. Regardless of the definition volume used, large gastric aspirates occurred in most enterally fed patients. Patient positioning was a significant influence, with a bed angle <30° associated with increased gastric aspirates (p = 0.0002). Constipation was more common among enterally fed patients than among orally fed ones (p = 0.001) and was associated with opioids (p = 0.009). Diarrhoea was associated with antibiotic use (p = 0.047). For enterally fed patients, the first bowel motion in the ICU occurred on average day 4.60 (standard deviation, 2.78), compared to day 2.72 (standard deviation, 1.67) for orally fed patients (p = 0.0001). CONCLUSION Alteration of upper and lower gastrointestinal motility is common in critically ill and early postoperative patients. Care should be taken in interpreting protocols that relate to gut function to avoid unnecessary interventions or interruptions to nutritional therapy.
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Affiliation(s)
- Tessa Heinonen
- Nutrition & Dietetics Program, School of Life and Environmental Sciences, University of Sydney NSW 2006, Australia.
| | - Suzie Ferrie
- Nutrition & Dietetics Program, School of Life and Environmental Sciences, University of Sydney NSW 2006, Australia; Intensive Care Service, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
| | - Clare Ferguson
- Intensive Care Service, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
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Hay T, Bellomo R, Rechnitzer T, See E, Ali Abdelhamid Y, Deane AM. Constipation, diarrhea, and prophylactic laxative bowel regimens in the critically ill: A systematic review and meta-analysis. J Crit Care 2019; 52:242-250. [PMID: 30665795 DOI: 10.1016/j.jcrc.2019.01.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/24/2018] [Accepted: 01/08/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Prophylactic laxative bowel regimens may prevent constipation in enterally-fed critically ill patients. However, their use may also increase diarrhea. We performed a systematic review to: 1. Explore the epidemiology of constipation and/or diarrhea in critically ill patients; and 2. Appraise trials evaluating prophylactic laxative bowel regimens. METHODS We searched MEDLINE, Embase, and CINAHL for publications that reported constipation or diarrhea in critically ill adult patients and/or prophylactic laxative bowel regimens. RESULTS The proportion of critically ill patients experiencing constipation was reported between 20% and 83% and the proportion experiencing diarrhea was reported between 3.3% and 78%. Six studies of prophylactic laxative bowel regimens were identified but only 3 randomised controlled trials were identified, and these were subjected to meta-analysis. Compared with placebo, a prophylactic laxative bowel regimen increased the risk of diarrhea (RR 1.58, 95% CI 1.22 to 2.04) but did not reduce the risk of constipation (RR 0.39, 95% CI 0.14 to 1.05), and did not affect the duration of mechanical ventilation, duration of ICU admission, or mortality. CONCLUSIONS Constipation and diarrhea occur frequently in the critically ill but data evaluating prophylactic laxative bowel regimens in such patients are sparse and do not support their use.
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Affiliation(s)
- Tyler Hay
- The University of Melbourne, Melbourne Medical School, Parkville, Victoria, Australia
| | - Rinaldo Bellomo
- The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, VIC 3050, Australia; Intensive Care Unit, The Austin Hospital, Heidelberg, Victoria, Australia; Intensive Care Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Tom Rechnitzer
- Intensive Care Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Emily See
- Intensive Care Unit, The Austin Hospital, Heidelberg, Victoria, Australia
| | | | - Adam M Deane
- 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.
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Batassini É, Beghetto MG. Constipation in a cohort prospective in adult critically ill patients: How much occurs and why? ENFERMERIA INTENSIVA 2018; 30:127-134. [PMID: 30553741 DOI: 10.1016/j.enfi.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/02/2018] [Accepted: 05/22/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the incidence and factors associated with constipation in adult critical care patients. DESIGN Prospective cohort study. SETTING Intensive care unit (ICU) of a high-complexity hospital from November 2015 to October 2016. PATIENTS Adults who were hospitalized for at least 72h in the ICU were followed from their admission to the ICU until their departure. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS In the 157 patients followed up, the incidence of constipation was 75.8%. The univariate analysis showed that constipated patients were younger, used more sedation and showed more respiratory and postoperative causes for hospitalization, while non-constipated patients were hospitalized more for gastrointestinal reasons. The use of vasoactive substances, mechanical ventilation and haemodialysis was similar between the constipated and non-constipated patients. Multivariate analysis, days of use of docusate+bisacodyl (HR: .79; 95% CI: .65-.96) of omeprazole or ranitidine (HR: .80; 95%CI: .73-.88) and lactulose (HR: .87; 95%CI: .76-.99) were independent protection factors for constipation. CONCLUSION Constipation has a high incidence among adult critical care patients. Days of drug use acting on the digestive tract (lactulose, docusate+bisacodyl and omeprazole and/or ranitidine) are able to prevent this outcome.
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Affiliation(s)
- É Batassini
- Postgraduate Program in Nursing, Nursing School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil; Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil.
| | - M G Beghetto
- Postgraduate Program in Nursing, Nursing School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
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