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Implementation of a bowel regimen protocol in critically ill children: A pilot study

Megan G Andrews1, Jamie L Miller1, Christine Allen2

  • 1Clinical and Administrative Sciences, Department of Pharmacy, College of Pharmacy, University of Oklahoma, Oklahoma City, OK, USA.

Journal of Pediatric Intensive Care
|June 20, 2019
PubMed

Insights

A new four-step bowel regimen (BR) was implemented for critically ill children receiving enteral nutrition. Over half of patients required escalation beyond the initial step, indicating a need for optimized constipation management in this population.

Area of Science:

  • Pediatric critical care medicine
  • Gastroenterology
  • Clinical nutrition

Background:

  • Constipation is a common issue in critically ill children receiving enteral nutrition.
  • No established bowel regimens (BR) exist for this specific patient population.
  • A comprehensive feeding and BR protocol was introduced in 2010.

Purpose of the Study:

  • To evaluate the outcomes of a newly implemented four-step bowel regimen (BR) in critically ill children.
  • To determine the percentage of patients requiring BR escalation beyond the initial protocol step.
  • To assess protocol deviations and adverse events associated with the BR.

Main Methods:

  • Retrospective study of pediatric patients (<18 years) who received the BR between July 2010 and April 2012.
  • Analysis of BR escalation, protocol deviations, and adverse events.
  • Statistical analysis to identify factors associated with BR escalation, including opioid use.

Main Results:

  • Fifty-four critically ill children were included; 79.6% received continuous opioid infusions.
  • 55.6% of patients required escalation beyond Step 1 of the BR.
  • Opioid duration was significantly associated with BR escalation (OR, 0.83; P = 0.047).

Conclusions:

  • This pilot study is the first to describe the outcomes of a four-step BR in critically ill children.
  • A significant proportion of patients required escalation of the BR, suggesting limitations in the initial protocol.
  • Further research is needed to establish optimal bowel regimens for managing constipation in critically ill pediatric patients.

Keywords:
Childrenbowel regimenconstipationcritically ill

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