Anesthésie et recherche clinique
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Frequency of Disturbed Defecation Pattern in Neurosurgical Critically Ill Patients and Influence on Intracranial Pressure and Intensive Care Treatment

Martin Kieninger, Tobias Finzel, Nina Zech, Milena Seemann, Sylvia Bele and Holger Künzig

Background: Inadequate bowel movement is a common problem in intensive care patients. Aim of this study was to quantify the frequency of disturbed defecation pattern in critical ill neurosurgical patients and examine the influence on intracranial pressure (ICP) and treatment on intensive care unit (ICU).

Patients and Methods: Data were collected retrospectively during treatment on a neurosurgical ICU over a period of three years. Daily bowel movement was regarded to be sufficient when stool volume was more than 150 ml liquid or mushy stool or the patient produced enough formed stool. Patients were classified into group “adequate defecation” when no period of more than three consecutive days without sufficient bowel movement was seen during ICU treatment or into group “inadequate defecation” respectively. A third group was built with patients showing constipation on seven consecutive days or longer.

Results: In a total of 73 recorded patients, 11 showed an adequate defecation pattern. Within the first ten days of ICU stay mean daily ICP values did not differ. However, patients with inadequate defecation had to be ventilated mechanically significantly longer (15,9 vs. 8,8 days) and had a significant longer need for ICU treatment (24,8 vs. 15,6 days). The mean cumulative dose of sedatives, sufentanil and norepinephrine was significantly higher in patients showing inadequate defecation. However, even long periods of constipation were not associated with a clinically relevant increase of ICP.

Conclusion: Neurosurgical ICU patients often show constipation. This does not cause elevated ICP values compared to patients without constipation. Disturbed bowel movement is associated with higher dosage of analgosedation and vasopressor therapy. Patients without constipation have to be ventilated less long and can be discharged from ICU earlier.