title: Constipation incidence and impact in medical critical care patients: importance of the definition criterion.
abstract: BACKGROUND
  Constipation incidence and impact remain controversial in the ICU. This may depend on the definition criterion used in the previous studies on the field. We aimed to determine the frequency and significance of constipation according to its definition criterion.
  
  
  METHODS
  This is a prospective observational study. Adult patients without a cause of transit time modification and laxative intake within the first 3 days were screened. Constipation was defined by a first stool passage occurring after 3 days of ICU stay. Thereafter, we identified two subgroups of patients: absence of stool passage more than 3 days but less than 6 days (3-day subgroup), and no stool passage for 6 days or more (6-day subgroup). Survival, length of stay and time spent under mechanical ventilation (MV) were compared according to constipation status.
  
  
  RESULTS
  Among 189 included patients [age 60.8 (49.5-74.2) years, SAPS II 44 (34-53)], 98 (51.9%) exhibited constipation (3-day subgroup n=53, 6-day subgroup n=45). Constipated patients were more likely to receive MV, sedation, vasopressors, enteral nutrition and neuromuscular blocking agents. ICU length of stay and time spent under MV was longer in the 6-day subgroup but not in the 3-day subgroup of patients.
  
  
  CONCLUSIONS
  With regard to outcomes, defining constipation by the absence of stool passage less than 6 days after ICU admission does not identify a specific subset of population. Further studies on the management of this condition should focus on these 'long-term' constipated patients.
authors.affiliation: aIntensive Care Unit, Assistance Publique-Hôpitaux de Paris, Antoine Béclère Hospital, Clamart bAP-HP, Intensive Care Unit, Louis Mourier Hospital, Colombes cInstitut National de la Santé et de la Recherche Médicale, INSERM, IAME 1137 dUniv Paris Diderot, IAME 1137, Sorbonne Paris Cité, Paris eInstitut National de la Santé et de la Recherche Médicale, INSERM U999, Le Plessis Robinson, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Prat
authors.forename: Jonathan
authors.initials: J
authors.lastname: Messika
authors.forename: Alexandre
authors.initials: A
authors.lastname: Avenel
authors.forename: Frédéric
authors.initials: F
authors.lastname: Jacobs
authors.forename: Jérome
authors.initials: J
authors.lastname: Fichet
authors.forename: Matthieu
authors.initials: M
authors.lastname: Lemeur
authors.forename: Jean-Damien
authors.initials: JD
authors.lastname: Ricard
authors.forename: Benjamin
authors.initials: B
authors.lastname: Sztrymf
mesh_terms: D000368:Aged; D003248:Constipation / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D003422:Critical Care; D016638:Critical Illness / Q000453:epidemiology* / Q000401:mortality; D003672:Defecation; D005260:Female; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors; D013997:Time Factors