title: Prophylaxis Versus Treatment Use of Laxative for Paralysis of Lower Gastrointestinal Tract in Critically Ill Patients.
abstract: OBJECTIVE
  To evaluate the prevalence of lower gastrointestinal tract paralysis and to compare the success to achieve defecation between treatment and prophylaxis strategies.
  
  
  BACKGROUND
  Laxatives use is commonly the first-level measure to achieve defecation in critically ill patients with lower gastrointestinal tract paralysis. Studies comparing prophylaxis versus treatment of lower gastrointestinal tract paralysis have not been performed yet.
  
  
  METHODS
  We designed 3 sequential phases of 4 months each: observational phase, treatment phase, and prophylaxis phase. First-level measure was intermittent polyethylene glycol (PEG) 4000 by nasogastric tube. Second-level measures were enema, neostigmine, and continuous PEG. Primary endpoints were the prevalence of constipation for the observational phase and the number of patients that failed to achieve defecation with first-level measures for the treatment and prophylaxis phases.
  
  
  RESULTS
  Paralysis of lower gastrointestinal tract in the observational phase was found in 57 of 63 patients (90.5%). Failure to achieve defecation with the first-level measure occurred in 16 of 64 patients (25%) in the treatment phase and in 6 of 70 patients (8.6%) in the prophylaxis phase (P=0.01). Eighteen measures of second level were applied in the treatment phase and 6 in the prophylaxis phase.
  
  
  CONCLUSIONS
  Paralysis of the lower gastrointestinal tract in mechanically ventilated ICU patients is common. PEG given as prophylaxis on the first day after mechanical ventilation is associated with faster resolution of paralysis of gastrointestinal tract than PEG given as a treatment on day 4.
authors: Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain.
authors: Begoña
authors: B
authors: Guardiola
authors: Juan A
authors: JA
authors: Llompart-Pou
authors: Jordi
authors: J
authors: Ibáñez
authors: Joan M
authors: JM
authors: Raurich
mesh_terms: D000328:Adult; D000368:Aged; D003248:Constipation / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D016638:Critical Illness; D003672:Defecation / Q000187:drug effects*; D004334:Drug Administration Schedule; D004733:Enema; D005260:Female; D005769:Gastrointestinal Motility / Q000187:drug effects*; D006801:Humans; D007362:Intensive Care Units; D054368:Laxatives / Q000008:administration & dosage*; D041741:Lower Gastrointestinal Tract / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000008:administration & dosage*; D010243:Paralysis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D015995:Prevalence; D012121:Respiration, Artificial; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D054368:Laxatives; D009388:Neostigmine; D011092:Polyethylene Glycols; C000595214:polyethylene glycol 4000