43. The impact of the introduction of a protocol for prevention of constipation in critically ill patients (443)

Gillian Ritchie, Senior Nurse Research & Development, Critical Care Directorate, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, United Kingdom
Co authors: Richard Wenstone, Clare Sugre, Lorraine Burgess & Sofia Mostafa
Gillian.ritchie@rlbuht.nhs.uk

Abstract:

Background:

Management of constipation can be overlooked in critically ill patients in intensive care units. We reported that its incidence in ICUs was high and it could cause failure to wean patients from mechanical ventilation (Mostafa et al 2003). We therefore introduced a protocol for prevention of constipation in our patients.

Aim:

This abstract presents the results of our second study, after protocol introduction.

Method:

Constipation was defined as ‘failure of bowel to move for >3 consecutive days’ (Hill et al 1998). Patients admitted to the ICU for >3 days were included in the study. Those who had recent bowel surgery were excluded. Patients’ age, sex, APACHE II score, length of stay in ICU, diagnosis and the incidence & duration of constipation were recorded. The volume of gastric aspirates, ability to enterally feed or wean patients from mechanical ventilation, and bowel care [e.g. use of laxatives] were noted. Data was analysed using the Fishers Exact test.

Results:

Data were prospectively collected over a 3 months’ period. Group I, after protocol introduction, comprised 42 patients [24 male] who were included in the study. Constipated patients were 17 [40%], 4 [24%] of whom failed to wean from controlled ventilation. Only 3 out of 25 [12%] non-constipated patients failed to wean.

Discussion:

Constipation can cause patient discomfort and complications including distension, vomiting, restlessness, gut obstruction and perforation. A significantly higher incidence of constipation was noted in our patients before the protocol was introduced [Group II] [40 out of 48 patients (83%)] compared with Group I, p<0.0001]. Conclusion The introduction of the protocol reduced the incidence of constipation in ICU. This study also confirmed previous findings that more constipated patients fail to wean from mechanical ventilation than non-constipated patents. These findings highlight the need for further investigations.

Biography:

I am currently a senior nurse in research and development at the Royal Liverpool University Hospital. I have recently completed a Masters in Research. Previous experience is as a Sister working in Critical Care.