• Anantha Padmanabhan, Mark Stern, Judith Wishin, Mari Mangino, Karen Richey, Mary DeSane, and Flexi-Seal Clinical Trial Investigators Group.
• Department of Surgery at Mt Carmel East Hospital, Columbus, OH, USA. apaddy@phy.mchs.com
• Am. J. Crit. Care. 2007 Jul 1;16(4):384-93.

BackgroundManagement of fecal incontinence is a priority in acute and critical care to reduce risk of perineal dermatitis and transmission of nosocomial infections.ObjectiveTo evaluate the safety of the Flexi-Seal Fecal Management System in hospitalized patients with diarrhea and incontinence.MethodsA prospective, single-arm clinical study with 42 patients from 7 hospitals in the United States was performed. The fecal management system could be used for up to 29 days. The first 11 patients (all from critical care) underwent endoscopic proctoscopy at baseline; 8 of these had endoscopy again after treatment. The remaining 31 patients (from critical or acute care) did not have endoscopy.ResultsRectal mucosa was healthy after use of the device in all patients who had baseline and follow-up endoscopy. Physicians and nurses reported that the system was easy to insert, remove, and dispose of; its use improved management of fecal incontinence; and it was practical, caregiver- and patient-friendly, time-efficient, and efficacious. Skin condition improved or was maintained in more than 92% of patients. Patients' reports of discomfort, pain, burning, or irritation were uncommon. Adverse events were reported for 11 patients (26%). Death (considered unrelated to study treatment) occurred in 5 patients, 2 patients had generalized skin breakdown, and 1 patient had gastrointestinal bleeding after 4 days of treatment.ConclusionsThe fecal management system can be used safely in hospitalized patients with diarrhea and fecal incontinence. Additional well-designed, controlled clinical trials may help to measure clinical and economic outcomes associated with the device.

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