title: Pharmacologic management of constipation in the critically ill patient.
abstract: OBJECTIVE
  To compare the effectiveness of common laxatives in producing a bowel movement in patients admitted to a medical intensive care unit (MICU).
  
  
  METHODS
  Retrospective medical record review.
  
  
  METHODS
  MICU of an academic medical center.
  
  
  METHODS
  Ninety-five patients admitted to the MICU from July 1-October 31, 2004.
  
  
  RESULTS
  Fifty patients satisfied the inclusion criteria. Patient-specific data such as age, weight, sex, length of MICU stay, Acute Physiology and Chronic Health Evaluation (APACHE) II score, dietary intake, opioid intake, laxative intake, and bowel movements were recorded during the first 96 hours of admission. Logistic regression analysis was used to compare patients who did and did not have a bowel movement. Of the 50 patients, 25 did not have a bowel movement during the first 96 hours of MICU admission. Patients given a stimulant laxative (senna, bisacodyl) and/or an osmotic laxative (lactulose, milk of magnesia) were more likely to have a bowel movement (odds ratio [OR] 26.6, 95% confidence interval [CI] 3.2-221, p=0.002). Opioid intake, expressed as logarithmic morphine equivalents, was negatively associated with occurrence of a bowel movement (OR 0.76, 95% CI 0.59-0.97, p=0.027). Disease severity, as determined by APACHE II score, was also negatively associated with a bowel movement (OR 0.84, 95% CI 0.7-0.99, p=0.04).
  
  
  CONCLUSIONS
  Critically ill patients have a high frequency of constipation, and opioid therapy is a significant risk factor. Routine administration of stimulant or osmotic laxatives should be considered for this patient population.
authors.affiliation: Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona 85721-0207, USA.
authors.forename: Asad E
authors.initials: AE
authors.lastname: Patanwala
authors.forename: Jacob
authors.initials: J
authors.lastname: Abarca
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Huckleberry
authors.forename: Brian L
authors.initials: BL
authors.lastname: Erstad
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects; D002400:Cathartics / Q000627:therapeutic use*; D003248:Constipation / Q000139:chemically induced / Q000188:drug therapy*; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012676:Senna Extract / Q000627:therapeutic use
chemical_list: D000701:Analgesics, Opioid; D002400:Cathartics; D012676:Senna Extract