Related Experiment Video
Updated: Sep 13, 2025
A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition
Published on: September 20, 2019
A cluster double-crossover trial of early versus delayed aperient use in mechanically ventilated, enterally fed
Yaodong Tang1, Glenn Eastwood1, Nuanprae Kitisin2
1Department of Intensive Care, Austin Hospital, Melbourne, Australia.
Insights
Delaying aperient administration in intensive care unit (ICU) patients receiving enteral feeding did not change the overall incidence of diarrhea. However, it did delay the onset of diarrhea, suggesting limited impact on this common complication.
Area of Science:
- Critical Care Medicine
- Gastroenterology
- Clinical Pharmacology
Background:
- Aperient use in enterally fed, intubated, and mechanically ventilated intensive care unit (ICU) patients is controversial due to associated diarrhea.
- The impact of aperient timing on diarrhea and related complications in this vulnerable patient population requires further investigation.
Purpose of the Study:
- To assess if the timing of aperient administration affects the incidence and onset of diarrhea in enterally fed, mechanically ventilated ICU patients.
- To evaluate the influence of early versus delayed aperient use on secondary outcomes such as ileus, ICU length of stay, and mortality.
Main Methods:
- A cluster, double-crossover, randomized trial was conducted involving mechanically ventilated, enterally fed adults.
- Patients were assigned to either early aperient use (day 1 of enteral feeding) or delayed aperient use (day 6 of enteral feeding).
- Bayesian analysis was employed to analyze primary outcomes (diarrhea occurrence) and secondary outcomes.
Main Results:
- The overall incidence of diarrhea was similar between the delayed (42.4%) and early (44.9%) aperient groups.
- Diarrhea onset was significantly delayed in the delayed aperient group.
- The occurrence of diarrhea after day 6 was substantially lower in the delayed aperient group (21.2% vs. 44.9%).
Conclusions:
- The timing of aperient administration did not significantly alter the overall occurrence of diarrhea in critically ill, enterally fed patients.
- Delaying aperient administration effectively postponed the onset of diarrhea.
- These findings suggest that while delaying aperients may not reduce the overall incidence, it can mitigate the timing of diarrhea in this patient cohort.
Background:
Aperient use in enterally fed, intubated, invasively mechanically ventilated intensive care unit (ICU) patients remains controversial and is associated with diarrhoea. The aim of this study was to assess whether the timing of aperient administration impacts the incidence and timing of diarrhoea and related complications in such patients.
Methods:
We conducted a cluster, double-crossover, randomised trial in mechanically ventilated, enterally fed adults. We compared "delayed" aperient use (started on day 6 of enteral feeding) to "early" aperient use (started on day 1 of enteral feeding). The primary outcome was the occurrence of diarrhoea. Secondary outcomes included time until first defecation, rate of faecal management device insertion, rate of ileus, ICU length of stay, and mortality. Data were analysed using a Bayesian analysis.
Results:
Of the 177 patients included, 42.4% in the delayed aperient group and 44.9% in early group developed diarrhoea (odds ratio: 0.91 [95% credible interval: 0.52 to 1.61]; probability of benefit: 62.4%). Diarrhoea, however, occurred later in patients in the delayed aperient group. Moreover, the occurrence of diarrhoea after day 6 was less in the delayed aperients group (21.2% vs. 44.9%; odds ratio: 0.37 [95% credible interval: 0.20 to 0.68]; probability of benefit: 99.9%). Other secondary outcomes including rate of ileus, ICU length of stay, and mortality did not show significant difference.
Conclusion:
The timing of aperient administration did not impact the occurrence of diarrhoea or other patient-centred outcomes but delayed its onset. These findings suggest that delaying aperients has limited impact on diarrhoea.
More Related Videos
06:28E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
06:59A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
Related Concept Videos
01:15Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube...
01:16Crossover Experiments
Crossover designs are performed even with smaller sample sizes since the samples can act as their controls. These are better than simple randomized trials since patients are exposed to all the treatments.
01:18Two-Compartment Open Model: IV Bolus Administration
The disparity between drug input and the sum of drug transfer rates between...
01:26Enteral Nutrition I: Orogastric and Nasogastric Feeding
Orogastric (OG) and nasogastric (NG) feeding are two standard methods used for enteral nutrition. Enteral nutrition is often preferred over...
01:19One-Compartment Open Model for IV Bolus Administration: General Considerations
The drug's presence in the body is defined by an equation representing the difference between the rates of drug entry and exit. Key parameters—elimination rate constant,...
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...