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

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.