Diarrhoea in the critically ill.
OBJECTIVE
The purpose of this review is to update the knowledge on diarrhoea, a common problem in critically ill patients. Epidemiological data will be discussed, with special emphasis on diarrhoea in tube-fed patients and during antibiotic therapy. The possible preventive and therapeutic measures will be presented.


RESULTS
The need for concise definitions of diarrhoea was recently re-emphasized. The use of pump-driven continuous instead of intermittent enteral feeding is less often associated with diarrhoea. The discontinuation of enteral feeding during diarrhoea is not justified. Clostridium difficile-associated diarrhoea is frequent during antibiotic therapy with quinolones and cephalosporins. Formulas enriched with water-soluble fibres are probably effective to prevent diarrhoea, and promising data on the modulation of gut microflora with probiotics and prebiotics were recently released.


CONCLUSIONS
Diarrhoea is common in critically ill patients, especially when sepsis and hypoalbuminaemia are present, and during enteral feeding and antibiotic therapy. The management of diarrhoea includes generous hydration, compensation for the loss of electrolytes, antidiarrheal oral medications, the continuation of enteral feeding, and metronidazole or glycopeptides in the case of moderate to severe C. difficile colitis. The place of enteral formulas enriched with water-soluble fibres, probiotics and prebiotics is not yet fully defined.
Department of Intensive Care, Centre Hospitalier, Universitaire du Sart Tilman, Liège, Belgium.
Patricia
P
Wiesen
André
A
Van Gossum
Jean-Charles
JC
Preiser
D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D016638:Critical Illness; D003967:Diarrhea / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D012307:Risk Factors
D000900:Anti-Bacterial Agents