Julian Robles, MD1, Leah Laageide, MD1, Zaheer Akhtar, DO1, Carlos Robles, BS2; 1Unity Point Health, Des Moines, IA; 2Harvard University, Cambridge, MA
Introduction: Gastrointestinal dysfunction is a common adverse outcome in critically-ill patients. Sedated and mechanically ventilated patients are a particularly high-risk group prone to constipation. This study aimed to identify the incidence and associated outcomes of constipation in this high-risk group. Methods: Data was obtained from the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC) Database v1.4 with the following inclusion criteria: >18 years old, admitted to MICU, and on mechanical ventilation receiving fentanyl infusion for sedation and analgesia. Exclusion criteria entailed intubation for less than 48 hours, intraabdominal surgery during admission, a new or chronic stoma. Patients were stratified by severity of constipation, classically defined as fewer than 3 bowel movements (BMs) in 7 days. Subgroups included: (G1) < 1 bowel movements (BM) in 7 days, (G2) 1-2 BMs in 7 days, and (G3) 3+ BMs in 7 days, defined as “non-constipated” patients. Outcome differences identified included in-hospital mortality, hours on a ventilator, and length of stay (LOS). Results: A total of 355 patients met inclusion criteria. The prevalence of overall constipation (fewer than 3 BMs in 7 days) was 74%. Comparison of in-hospital mortality and LOS in non-constipated patients (G1) versus all constipated patients (G2 & G3) showed a higher mortality (45% vs 31%, P = 0.017) but lower LOS (18 days vs 27 days, P < 0.001) in G3. A similar trend was demonstrated comparing G1 with G2 individually with an in-hospital mortality (45% vs 27%, P = 0.006) and lower LOS (18 days vs 23 days, P = 0.009). Comparing G1 with G3 demonstrated significant differences in LOS (18 days vs 30 days, P < 0.001). We found no differences in time spent under mechanical ventilation between the constipated and non-constipated groups. No significant differences were identified in groups comparisons of age, sex, weight, or choice of prophylactic bowel regimen. Discussion: A high prevalence of constipation (74%) was identified in mechanically ventilated patients on fentanyl infusions. Furthermore, constipated patients were found to have a statistically significant difference in LOS compared to non-constipated patients. Findings support constipation as a marker for ICU morbidity and may be amplified by future studies on the effect of prophylactic bowel regimens on outcomes, including LOS and in-hospital mortality.
Disclosures: Julian Robles indicated no relevant financial relationships. Leah Laageide indicated no relevant financial relationships. Zaheer Akhtar indicated no relevant financial relationships. Carlos Robles indicated no relevant financial relationships.