Factors associated with time to defecate and outcomes in critically ill patients: a prospective, multicentre, observational study

Abstract

Summary 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.

The effect of opioids on gastrointestinal function in the ICU

“…The association between the clinical outcomes of ICU patients and the time of defecation is controversial. Some studies have suggested that constipation was associated with increased mortality, but some studies demonstrated that constipation was related to a more prolonged ICU stay but not mortality [ 44 – 46 ]. Therefore, it should be recognized that it is not whether defecation impacts mortality but failure to defecate after medication [ 45 ].…”

“…Constipation occurred in 16–83% of patients in the ICU and was associated with delayed enteral feeding, bacterial translocation, and delayed weaning from mechanical ventilation [ 11 ]. However, there is no direct evidence that opioid administration is independently associated with time to defecate in critically ill patients [ 44 ]. Some studies only indirectly demonstrated that opioid administration had little effect on constipation in the ICU setting (Table 2 ).…”

Pandemic risk management using engineering safety principles

“…An early report from China stated a mortality rate of 80% in ICU; however, this mortality rate dropped to one-third and improving over time ( Abate et al, 2020 ; Launey et al, 2020 ). We have assumed a 10% admission rate to ICU and 30% mortality rate of intensive care units in our calculation.…”

The evolution of evidence‐based medicine in critical care: have we left ‘time to defecation’ behind?

“…In this issue, Launey et al. report their prospective multicentre observational study of factors associated with time to defecation and outcomes in critically ill patients [1]. They included data from 396 patients, of which 60 (15.2%) passed no stool during their stay.…”

“…In this issue, Launey et al report their prospective multicentre observational study of factors associated with time to defecation and outcomes in critically ill patients [1].…”