title: Methods of bowel management in critical care: a randomized controlled trial.
abstract: OBJECTIVE
  The purpose of this study was to compare 3 methods of bowel management to control fecal incontinence in adult critical care patients and their effect on incontinence-associated dermatitis, pressure ulcer prevalence, and clinician satisfaction.
  
  
  METHODS
  Fifty-nine adult patients in critical care with liquid fecal incontinence were recruited from 6 critical care units in a large Midwest healthcare system.
  
  
  METHODS
  Subjects were randomly assigned to 1 of 3 groups: bowel management system catheter, rectal/nasopharyngeal trumpet, or usual care. Subjects were assessed daily for incontinence-associated dermatitis, pressure ulcer prevalence, and other clinical data. Direct care nurse satisfaction with each method was evaluated by self-administered survey.
  
  
  RESULTS
  Incontinence-associated dermatitis severity and pressure ulcer prevalence did not differ across groups at baseline. Over time, the change in incontinence-associated dermatitis severity score was significantly different across groups (P < .001). There were no significant differences in proportion of patients experiencing pressure ulcers during the study among groups. Clinicians reported significantly greater satisfaction with the bowel management system (P = .007) and rectal trumpet (P = .001) as compared to usual care. In addition, economic and safety benefits were identified with use of internal fecal devices. Specifically, an economic savings of $3100 to $3400 per 29 days of care was identified. Subjects experienced no adverse side effects when internal devices were used.
  
  
  CONCLUSIONS
  Results of this randomized controlled trial provide new information for the care of patients with fecal incontinence in the critical care setting. Incontinence-associated dermatitis severity scores differed across groups over time, pressure ulcer prevalence did not differ across groups over time, use of an internal device or bowel management system improved clinician satisfaction, and the use of internal fecal methods was more cost-effective than usual care.
authors.affiliation: Indiana University Health-Methodist Hospital, Indianapolis 46206, USA. jpittma3@iuhealth.org
authors.forename: Joyce
authors.initials: J
authors.lastname: Pittman
authors.forename: Terrie
authors.initials: T
authors.lastname: Beeson
authors.forename: Colin
authors.initials: C
authors.lastname: Terry
authors.forename: William
authors.initials: W
authors.lastname: Kessler
authors.forename: Lisa
authors.initials: L
authors.lastname: Kirk
mesh_terms: D000368:Aged; D003422:Critical Care; D003872:Dermatitis / Q000209:etiology / Q000628:therapy; D005242:Fecal Incontinence / Q000150:complications / Q000453:epidemiology / Q000451:nursing / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D003668:Pressure Ulcer / Q000453:epidemiology