title: Impaired gastrointestinal transit and its associated morbidity in the intensive care unit.
abstract: OBJECTIVE
  To determine the proportion of critically ill adults developing impaired gastrointestinal transit (IGT) using a clinically pragmatic definition, its associated morbidity and risk factors.
  
  
  METHODS
  Critically ill adult patients receiving enteral nutrition for ≥ 72 hours and mechanically ventilated for ≥ 48 hours were prospectively identified. IGT was defined as absence of a bowel movement for ≥ 3 days, treatment for constipation, and one of the following: (1) radiologic confirmed ileus, (2) feed intolerance, (3) abdominal distention, or (4) gastric decompression.
  
  
  RESULTS
  One thousand patients were screened, and 248 were included for analysis. Fifty patients (20.1%; 95% confidence interval, 15.1-25.6%) developed IGT persisting for 6.5 ± 2.5 days. Patients with IGT had longer lengths of intensive care unit stay and were less likely to reach nutrition targets compared to patients without IGT or traditional definitions of constipation. Daily opioid use and pharmacological constipation prophylaxis were identified risk factors for IGT.
  
  
  CONCLUSIONS
  Traditional definitions of constipation or ileus in intensive care unit patients are simplistic and lack clinical relevance. Pragmatically defined IGT is a common complication of critical illness and is associated with significant morbidity. Future interventional studies for IGT in critically ill adults should use a more clinically relevant definition and evaluate energy deficits and lengths of stay as clinically relevant outcomes.
authors: Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors: Tiffany
authors: T
authors: Nguyen
authors: Anne-Julie
authors: AJ
authors: Frenette
authors: Christel
authors: C
authors: Johanson
authors: Robert D
authors: RD
authors: Maclean
authors: Rakesh
authors: R
authors: Patel
authors: Allison
authors: A
authors: Simpson
authors: Avinder
authors: A
authors: Singh
authors: Katelyn S
authors: KS
authors: Balchin
authors: Dean
authors: D
authors: Fergusson
authors: Salmaan
authors: S
authors: Kanji
mesh_terms: D018806:APACHE; D016009:Chi-Square Distribution; D003248:Constipation / Q000175:diagnosis*; D016638:Critical Illness; D004750:Enteral Nutrition; D005260:Female; D005772:Gastrointestinal Transit; D006801:Humans; D045823:Ileus / Q000175:diagnosis*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D012121:Respiration, Artificial; D012307:Risk Factors
keywords: Bowel; Constipation; Critical illness; Gastrointestinal disease; Ileus; Intensive care unit