• Nicholas Wilson, Rinaldo Bellomo, Tyler Hay, Timothy Fazio, Jasmine Entwistle, Jeffrey J Presneill, Ali AbdelhamidYasmineYIntensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia., and Adam M Deane.
• Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia. Nicholas.Wilson@mh.org.au.
• Crit Care Resusc. 2020 Jun 1; 22 (2): 152157152-157.

ObjectiveTo determine the frequency, indications and complications associated with the use of faecal diversion systems (rectal tubes) in critically ill patients.DesignA single centre observational study over 15 months.SettingIntensive care unit (ICU).ParticipantsPatients admitted during this period.Main Outcome MeasuresFrequency of rectal tubes utilisation in ICU, as well as associated adverse events, with major events defined as lower gastrointestinal bleeding associated with defined blood transfusion of two or more units of red cells or endoscopy or surgical intervention.ResultsOf 3418 admission episodes, there were 111 episodes of rectal tubes inserted in 99 patients. Rectal tubes remained indwelling for a median of 5 days (range, 1-23) for a total of 641 patient-days. The most frequent indication for insertion was excessive bowel motions. A major adverse event was observed in three patients (3%; 0.5 events per 100 device days). Two patients underwent laparotomy and one patient sigmoidoscopy. These patients received between two and 23 units of packed red blood cells. Patients who had a rectal tube inserted had a substantially greater duration of ICU admission (mean, 14 days [SD, 14] v 2.8 days [SD, 3.7]) and hospital mortality (15% v 7.7%; risk ratio, 2.0; 95% CI, 1.2-3.4) as well as an overall higher Australian and New Zealand Risk of Death (ANZROD) score (mean, 27 [SD, 22] v 12.6 [SD, 20]).ConclusionRectal tubes appear to be frequently inserted and can lead to major adverse events in critically ill patients.

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