Assessing the bowel function of critically ill children: a pilot study
Nathan Smalley1, Venkat Vangaveti2
1Paediatric Intensive Care, Townsville Hospital, Townsville, QLD, Australia. nathansmalley@me.com.
Insights
Critically ill children often do not pass stools, with loose or watery stools being most common. Narcotic use significantly impacts bowel function in pediatric intensive care units.
Area of Science:
- Pediatric critical care medicine
- Gastrointestinal physiology in children
Background:
- Bowel dysfunction is a common issue in critically ill patients.
- Understanding bowel function in pediatric intensive care is crucial for patient management.
Purpose of the Study:
- To characterize the bowel function of critically ill children.
- To identify factors influencing bowel function, including medication and nutrition.
Main Methods:
- Prospective observational study in a tertiary pediatric intensive care unit.
- Monitored children under 16 admitted for over 24 hours.
- Collected data on demographics, bowel function, stool form, medications, and nutrition.
Main Results:
- No bowel motions observed on 56.2% of monitored days.
- Loose or watery stools were predominant (22%) when motions occurred.
- Narcotic use (71.2%) was significantly associated with non-defecation days.
Conclusions:
- Critically ill children experience prolonged periods of non-defecation.
- Formed stools are rare, and bowel dysfunction is prevalent.
- Further research is needed to fully define bowel function in this population.
Objective:
To describe the bowel function of critically ill children.
Design, Setting And Participants:
A prospective, observational study, in a regional tertiary intensive care unit, of children under 16 years of age who were admitted for more than 24 hours. We collected demographic data and captured information on bowel function and stool form and on factors that may affect these, such as medicines and nutrition.
Main Outcome Measures:
Bowel activity and duration of administration of aperients and narcotics.
Results:
Forty-seven patients (28 boys) with a median age of 3.66 years (IQR, 1-7.62 years) were enrolled and monitored for 219 ICU days, 134 (61.2%) of which were ventilation-bed days. There were no bowel motions seen on 123 days (56.2%), and of the days when motions were passed, the predominant stool form was loose or watery (22%). One patient had clinical features of constipation (0.5%). Aperients were used, predominantly docusate, on 38 days (17.4%), and prokinetics on 28 days (12.8%). Narcotics were used on 156 days (71.2%), and narcotic duration was significantly associated with non-defecation days (Spearman ρ= 0.55, n = 33, P < 0.01). Clinically, reduced gut motility (recorded as absent bowel sounds or increased gastric residual volumes) was seen on a total of 31 days (68.9%).
Conclusions:
Critically unwell children needing more than 24 hours of intensive care have a state of non-defecation for most of the time, with formed stools being rare. Further observational studies will better define bowel function in critically unwell children.
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