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Incidence of opioid-induced constipation in the pediatric intensive care unit: A descriptive cohort study
Meghan D Roller1,2, Apurva Panchal3, Lori Duesing2,4
1Department of Pediatrics, Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Insights
Opioid-induced constipation (OIC) affects nearly 40% of pediatric intensive care unit (PICU) patients. While opioid use is common, other factors like neurological issues, trauma, or surgery also contribute to constipation in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Gastroenterology
- Pharmacology
Background:
- Opioid-induced constipation (OIC) is a recognized adverse effect of opioid analgesia.
- Limited data exists on the incidence and contributing factors of OIC in pediatric intensive care units (PICUs).
- Understanding OIC in PICU populations is crucial for optimizing patient care and outcomes.
Purpose of the Study:
- To determine the incidence of OIC in pediatric intensive care unit (PICU) patients.
- To investigate potential associations between OIC and increased morbidities or prolonged length of stay (LOS).
Main Methods:
- A single-center retrospective chart review was conducted over a 12-month period.
- Included patients were ≤18 years old and stayed in the PICU for ≥96 hours, receiving opioids.
- Data collected included bowel movement frequency, opioid administration details, and demographic/clinical information.
Main Results:
- 39.4% of eligible patients developed constipation.
- Constipation was more prevalent in older, heavier patients and those admitted for neurological issues, trauma, or abdominal surgery.
- No significant differences in constipation rates were found based on opioid dosage, duration, or administration method, or severity of illness.
Conclusions:
- Opioid use alone does not solely predict constipation in the PICU.
- Factors beyond opioid administration, such as underlying medical conditions and surgical procedures, play a significant role in OIC development.
- Further research is needed to elucidate multifactorial causes of OIC in critically ill children.
Background:
Opioid-induced constipation (OIC) is a well-known phenomenon, although there is limited literature evaluating the incidence of OIC in children admitted to the pediatric intensive care unit (PICU). The primary aim of this study was to determine the incidence of OIC in the PICU and to determine if it is associated with a higher rate of morbidities or prolonged length of stay (LOS).
Methods:
We conducted a single-center retrospective chart review from July 1, 2014, to June 30, 2015, in our PICU. We included all patients aged ≤18 years with a PICU stay of ≥96 h who received opioids during their admission. Data were collected on the frequency of bowel movements and characteristics of opioid administration. Demographic and clinical data were obtained from Virtual Pediatric Systems, LLC.
Results:
Of the 94 patients who met the study criteria, 39.4% developed constipation. These patients tended to be older (P = 0.06) and were noted to weigh more (P = 0.03). There was no significant difference in the total or median daily doses, duration of opioid treatment, or mode of administration. Constipation rates did not differ by the severity of illness. There was a higher incidence of constipation in the patients who were admitted for neurological issues or after trauma or abdominal surgery (P = 0.002). Patients with constipation had a longer LOS than patients without constipation, but the difference was not statistically significant.
Conclusion:
These results indicate that opioid use is not the sole risk factor for constipation in the PICU setting.
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