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A Study to Assess Bowel Pattern, its Associated Factors and Impact on Clinical Outcomes among Critically ill Patients Admitted in ICUs of a Tertiary Care Hospital, Ludhiana, Punjab

Dilranjan Kaur johal, Prabhjot Saini, Shivani Kalra, P.L. Gautam

Abstract


Background: Defecation and gastrointestinal motility functions are important in critically ill patients as they affect the quality of life. However, scant attention has been given to abnormal bowel pattern in critically ill patients. Aim: The objective of the present study was to assess bowel pattern, its associated factors, and impact on clinical outcomes among critically ill patients. Methods: A prospective cohort study was conducted on 50 critically ill patients who stayed for ≥3 days in ICUs of DMCH Ludhiana by total enumerative sampling technique. The tool used was socio demographic profile, clinical profile, bowel pattern assessment by daily record sheet and Bristol stool scale (1997), daily record sheet for vital assessment, and SAPS II (1993) to assess clinical outcome. Data was collected by self-report through structured interview, observations, records, and reports. Results: 50 patients were followed up for 324 observations. Inadequate bowel pattern was recorded in 62% (31), out of which 9.6% (3) had diarrhea and 90.3% (28) had constipation. Adequate bowel pattern was recorded in 38% (19) patients, among which 42% (8) had adequate pattern with laxatives and 58% (11) without laxatives. From total of 324 observations, there was no bowel action during 172 (53.1%) observations, while in 152 (46.9%) observations with bowel action, loose stools were identified on 75 observations (49.34%), and hard stool was present in 21 (6.48%) observations. There was significant association of late enteral nutrition (p = 0.001), comorbidity (hypertension) (p = 0.02), VCV mode (p = 0.01), PCO2 (p = 0.04) and male gender (p = 0.01) with inadequate bowel pattern. Delayed enteral nutrition increased the risk of inadequate bowel pattern (RR 1.99, p = 0.001). Anticonvulsants and ACE inhibitors increased the risk of inadequate bowel pattern (RR >1.5, p<0.01). Inadequate bowel pattern increased the risk of intubation for >6 days (RR 2, p = 0.02). Conclusion: Critically ill patients frequently have inadequate bowel pattern with constipation as the most common problem. Inadequate bowel pattern was significantly associated with male gender, HTN comorbidity, late enteral nutrition, VCV mode, and PCO2. Therefore, it is recommended that early detection and treatment of inadequate bowel pattern can reduce their stay in ICU.

 

 


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