Constipation in the critically ill

A systematic review and evidence-based protocol on constipation in the critically ill patient.

Abstract

Abstract

Aims and objectives: To define constipation in the critically ill patient and to develop an evidence-based protocol for how critical care nurses and physicians can prevent and treat constipation in the critically ill patient admitted in the ICU.

Background: Constipation is a common complication amongst critically ill patients. The rate of constipation is reported from 15-83%. Basic nursing tasks in a high-tech environment might get low priority and lead to care left undone. Constipation increases both morbidity and mortality and is associated with worse functional outcomes in these patients. Management of constipation is therefore of medical and health economic interest and is an area where significant improvement is possible.

Design: A systematic review was conducted supported by an expert librarian, and an evidence-based protocol was developed based on research findings and consensus from an interdisciplinary group.

Methods: 19 studies investigating preventative and management measures of constipation in the critically ill admitted in the ICU were included. Appraisal of Guidelines for Research and Evaluation (AGREE II) was used to provide rigorous methodology in the development of the evidence-based protocol. Critical Appraisal Skills Program (CASP) was applied to assess the quality of the included studies.  

Conclusion: A systematic interprofessional approach to prevention and treatment of constipation is important to be able to evaluate and improve continuously in an evidence-based manner.  More research is needed. Studies investigating non-pharmacological measures are scares.

Relevance to clinical practice: This evidence-based protocol represents a systematic (and not individual) approach to interprofessional prevention and treatment of constipation in the critically ill. This interprofessional approach may ensure better quality of advanced nursing care in the ICU. The evidence-based protocol must be implemented in education of advanced nursing and physician programs.