Critical Care Scenarios TIRBO 55: Bowel regimens
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Feb 21, 2024 Dive into the world of bowel health in the ICU as Brandon shares vital insights. Learn why patients struggle with constipation due to factors like immobility and opioids. He reveals his shift away from routine docusate and senna, advocating for polyethylene glycol as a go-to solution. Explore when to escalate dosage and the practicalities of administration. Discover alternatives like naloxegol and lactulose, and the importance of supportive measures. Conclude with tips to distinguish between ileus and constipation, ensuring patients get the best care.
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ICU Patients Commonly Become Constipated
- ICU patients are at high risk of constipation because of immobility, sedatives/opioids, lack of enteral intake, and inflammation.
- Preventing constipation is easier and preferable to treating established severe constipation.
Make PEG Your First-Line Strategy
- Use polyethylene glycol (PEG/Miralax) as your primary bowel regimen and increase dose if needed.
- You can give frequent doses up to bowel-prep quantities and stop once the patient has cleared.
Use Rectal Options For Nonenteral Patients
- If enteral access is not possible, use rectal therapies like suppositories or enemas for impacted stool.
- Consider manual disimpaction only when conservative measures and enemas fail, and give an enema beforehand to loosen stool.