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Wang M, Lu J, Lu Z, Wang Z, Wang Z, Wu C. Influencing Factors of Constipation in Elderly Patients With Intracerebral Hemorrhage: Implication for Clinical Care. Biol Res Nurs 2024; 26:390-398. [PMID: 38407112 DOI: 10.1177/10998004241229181] [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: 02/27/2024]
Abstract
Background: Constipation is common in elderly inpatients with intracerebral hemorrhage. This study aimed to construct a model for predicting the risk of constipation in elderly inpatients with intracerebral hemorrhage and to provide reference for formulating targeted intervention measures. Methods: Elderly patients with intracerebral hemorrhage who were treated in the department of Neurosurgery of a third-class hospital in Suzhou from January 2018 to September 2023 were included. Clinical data of patients with and without constipation were compared. Logistic regression analysis was used to explore the influencing factors of constipation in elderly patients with intracerebral hemorrhage, and R software was used to construct a line chart model to verify its predictive effect. Results: A total of 504 elderly patients with intracerebral hemorrhage were included. The incidence of constipation in elderly patients with cerebral hemorrhage was 63.9%. Logistic regression analysis showed that GCS score (OR = 1.094, 95%CI: 1.019∼1.174), hypertension (OR = 2.911, 95%CI: 1.797∼4.715), use of dehydrating agent (OR = 3.794, 95%CI: 2.337∼6.158), surgical treatment (OR = 3.986, 95%CI: 2.339∼6.793), use of sedative drugs (OR = 4.212, 95%CI:2.386-7.435), and limb paralysis (OR = 6.313, 95%CI:3.689∼10.803) were the independent risk factors for constipation in elderly patients with intracerebral hemorrhage. The area under the ROC curve of the prediction model was 0.872 (95%CI: 0.8401∼0.9033), the best critical value was 0.705, the sensitivity was 0.748, and the specificity was 0.857. Conclusion: The constipation risk prediction model of elderly patients with cerebral hemorrhage has good differentiation and calibration, which is helpful for health care providers to identify the risk of constipation in elderly patients with intracerebral hemorrhage.
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Affiliation(s)
- Meng Wang
- Department of Emergency, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Jue Lu
- School of Medical and Health Engineering, Changzhou University, Changzhou, China
| | - Ziwei Lu
- Department of Neurosurgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhong Wang
- Department of Neurosurgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhuo Wang
- School of Medical and Health Engineering, Changzhou University, Changzhou, China
| | - Chao Wu
- Department of Neurosurgery, First Affiliated Hospital of Soochow University, Suzhou, China
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2
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Aikawa G, Ouchi A, Sakuramoto H, Hoshino T, Enomoto Y, Shimojo N, Inoue Y. Association of early-onset constipation and diarrhoea with patient outcomes in critically ill ventilated patients: A retrospective observational cohort study. Aust Crit Care 2023; 36:737-742. [PMID: 36400625 DOI: 10.1016/j.aucc.2022.10.005] [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: 04/17/2022] [Revised: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Constipation and diarrhoea are closely related, but few studies have examined them simultaneously. OBJECTIVES The purpose of this study was to describe patient defecation status after intensive care unit (ICU) admission and determine the association between early-onset constipation and diarrhoea following ICU admission with outcomes for critically ill ventilated patients. METHODS Patients ventilated for ≥48 h in an ICU were retrospectively investigated, and their defecation status was assessed during the first week after admission. Early-onset constipation and diarrhoea were defined as onset during the first week of ICU admission. The patients were divided into three groups-normal defecation, constipation, and diarrhoea-and multiple comparisons were performed using the Kruskal-Wallis test and the Mann-Whitney U test with Bonferroni adjustment. Additionally, multivariable analysis was performed for mortality and length of stay using the linear and logistic regression models. RESULTS Of the 85 critically ill ventilated patients, 47 (55%) experienced early-onset constipation and 12 (14%) experienced early-onset diarrhoea. Patients with normal defecation and diarrhoea increased from the 4th and 5th day of ICU admission. Early-onset diarrhoea was significantly associated with the length of ICU stay (B = 7.534, 95% confidence interval: 0.116-14.951). CONCLUSIONS Early-onset constipation and diarrhoea were common in critically ill ventilated patients, and early-onset diarrhoea was associated with the length of ICU stay.
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Affiliation(s)
- Gen Aikawa
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan; Intensive Care Unit, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, Japan.
| | - Akira Ouchi
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, 6-11-1 Omika, Hitachi, Ibaraki, Japan
| | - Hideaki Sakuramoto
- Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyushu International College of Nursing, 1-1 Asty, Munakata, Fukuoka, Japan
| | - Tetsuya Hoshino
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Yuki Enomoto
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Nobutake Shimojo
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Yoshiaki Inoue
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
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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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Kamali M, Bagheri-Nesami M, Ghaemian A, Moosazadeh M, Esmaeili-Ahangarkelai N, Ghasemi Charati F, Haghighat S. The Effect of Acupressure on Preventing Constipation in Patients with Acute Myocardial Infarction under Primary Percutaneous Coronary Intervention. Middle East J Dig Dis 2022; 14:422-430. [PMID: 37547499 PMCID: PMC10404096 DOI: 10.34172/mejdd.2022.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 08/07/2022] [Indexed: 08/08/2023] Open
Abstract
Background: Cardiac patients are prone to experiencing constipation. The main purpose of the present study was to assess the effect of acupressure on preventing constipation in patients with acute myocardial infarction (AMI) under primary percutaneous coronary intervention. Methods: The present randomized clinical trial was conducted on 90 patients with AMI (30 patients in each group) who were randomly allocated based on inclusion criteria. The intervention was carried out among the patients with AMI on the acupressure points SJ6, LI4, ST25, and SP6 two times a day (10 am and 6 pm) for three sequential days. Results: On the first and second days of the study, all of the patients had no defecation, and the first defecation occurred on the third day of the study. In the intervention, sham, and control groups, 93.3%, 46.7%, and 50.0% had normal defecation on the third day of the study, respectively. The results of the Chi-square test revealed significant differences among the three groups (P<0.001). Conclusion: The results of the present study showed that patients with AMI in the intervention group had significant improvement in terms of stool consistency based on the Bristol stool scale. So, acupressure can be used as a nursing intervention in critical care units.
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Affiliation(s)
- Mahsa Kamali
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Masoumeh Bagheri-Nesami
- Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
- World Federation of Acupuncture-Moxibustion Societies (WFAS), Beijing, China
| | - Ali Ghaemian
- Fellowship of Interventional Cardiology, Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Gastrointestinal Cancer Research Center, Noncommunicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Science, Sari, Iran
| | - Nadali Esmaeili-Ahangarkelai
- Head of Scientific Studies Institute of Nadali Esmaeili and Training and Studies of Acupuncture Center
- Member of Executive Committee of World Federation of Acupuncture- Moxibustion Societies (WFAS), Beijing, China
| | - Fahimeh Ghasemi Charati
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Surgical Nursing, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sahar Haghighat
- PhD Student in Nursing, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
- Master of Nursing, Mazandaran University of Medical Sciences, Sari, Iran
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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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Impact of delayed transit in severe COVID 19 critical care patients: A retrospective analysis. Clin Res Hepatol Gastroenterol 2021; 45:101676. [PMID: 33716190 PMCID: PMC7948526 DOI: 10.1016/j.clinre.2021.101676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/23/2021] [Accepted: 03/03/2021] [Indexed: 02/04/2023]
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Abstract
BACKGROUND Much of the research and clinical commentary on COVID-19 have been focused on respiratory function. Pelvic floor therapists understand that both respiratory dysfunction and hospitalization can have an impact on pelvic floor function. This clinical commentary provides context as to how the long-term effects of COVID-19 could affect the pelvic floor as well as some generalized treatment considerations. DISCUSSION The respiratory diaphragm has an impact on the ability of the pelvic floor to contract and relax in a manner that will allow for both continence and elimination. COVID-19 survivors often have disability in this muscle of respiration that can lead to implications for both overactive and underactive pelvic floor. Commonly, this population is hospitalized for long periods of time, which can have long-term consequences on both bladder and bowel functioning including, but not limited to, incontinence, urinary retention, and constipation. Pelvic floor therapists must be prepared to adjust both their evaluation and treatment methods in consideration of this novel treatment population. CONCLUSIONS Because of the pervasive nature of this virus, pelvic floor physical therapists should be a part of the rehabilitation team treating these patients once they have become medically stable.Video abstract with sound available at http://links.lww.com/JWHPT/A36.
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Affiliation(s)
| | - Amelia Gray
- Department of Rehabilitation, OhioHealth, Columbus, Ohio
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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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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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