Evaluation about the efficacy of management of fecal evacuation in critically ill patients receiving early enteral nutrition

Abstract

Background & Purpose: Constipation and/or diarrhea may disturb early enteral feeding in critically ill patients. We developed a protocol for management of fecal evacuation depending on feces volume only. We also evaluated the efficacy of this protocol in critically ill patients.
Patients and Methods: Fifty-three critically ill patients who received enteral feeding for a period of 7 days in the intensive care unit of our hospital during the past three years were included in this study. Patients were divided in a pre-protocol group (n=24) and a post-protocol group (n=29). Daily volume of feces was measured for 7 days from the initiation of enteral feeding, and was retrospectively compared between two groups. Diarrhea and constipation were defined as more than 300 g/day of feces and no evacuation for 48 hours, respectively.
Results: Daily volume of feces in the post-protocol group was significantly decreased compared with that in the pre-protocol group. Frequency of diarrhea showed no significant difference between the two groups. Frequency of constipation and frequency of both diarrhea and constipation in the postprotocol group were significantly lower than those in the pre-protocol group (1.5±0.3 vs 0.7±0.2 days and 4.0±0.3 vs 2.6±0.3 days, respectively).
Conclusion: We introduced a protocol for management of defecation using daily fecal volume. This protocol decreased fecal volume and incidence of diarrhea and constipation in critically ill patients. Appropriate management of evacuation of feces using this protocol may facilitate enteral nutrition, resulting in improvement of prognosis in critically ill patients.