• Tyler Hay, Adam M Deane, Tom Rechnitzer, Kate Fetterplace, Rebecca Reilly, Melissa Ankravs, Michael Bailey, Timothy Fazio, James Anstey, Rohit D'Costa, Jeffrey J Presneill, Christopher M MacIsaac, and Rinaldo Bellomo.
• The University of Melbourne, Melbourne Medical School, Parkville, Victoria, Australia.
• J Crit Care. 2019 Aug 1; 52: 86-91.

PurposeProphylactic laxative regimens may prevent constipation but may increase diarrhea and subsequent rectal tube insertion. Our aim was to compare three prophylactic laxative regimens on the rate of rectal tube insertion (primary outcome) and major constipation- or diarrhea-associated complications.Material And MethodsWe conducted a cluster-crossover trial. Three pods in a single ICU were each randomized to one of three regimens for four months with rolling cross-over. All mechanically-ventilated and enterally-fed adult patients received either regimen: A) one coloxyl with senna BD from day one; B) two coloxyl with senna +20 ml lactulose BD commencing on day 3; or C) two coloxyl with senna tablets +20 ml lactulose BD commencing on day 6.ResultsWe enrolled 570 patients (A = 170, B = 205, C = 195) with similar baseline features. Overall, 53 (9.3%) patients received a rectal tube, and insertion rate was not statistically different between the three regimens (A = 12.9%, B = 7.8%, C = 7.7%; p = 0.15). The proportions of patients with other major constipation- or diarrhea-associated complications were similar, as were major patient-centred outcomes.ConclusionEarlier commencement of a prophylactic coloxyl-based laxative regimen (day 1 or 3) did not affect the rates of complications associated with constipation or diarrhea when compared to delayed introduction (day 6).Copyright © 2019. Published by Elsevier Inc.

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