Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, 3-19-18, Nishi-Shinbashi Minato-ku, Tokyo, Japan.
Department of Intensive Care Medicine, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan.
J Anesth. 2022 Jun;36(3):349-358. doi: 10.1007/s00540-022-03050-x. Epub 2022 Feb 21.
There are several causes for delayed constipation in critically ill patients. Constipation in critically ill patients is reportedly associated with poor outcomes. However, a consistent definition for constipation and reports on the prognosis of critically ill patients with constipation are lacking. Therefore, we aimed to determine the epidemiology of constipation during critical illness, and assess the association between constipation and in-hospital mortality based on the two definitions of constipation used in previous studies.
This retrospective cohort study comprised adult patients in a general intensive care unit (ICU) during 2011-2018. We retrieved the information regarding their bowel movements and assessed the impact of constipation on the in-hospital mortality based on the previous definitions (absence of defecation for 72 and 144 h).
Among the 1933 adult ICU patients included, the proportion of patients with constipation decreased with a longer duration of constipation (72 h: 67%, 144 h: 36%). In-hospital mortality in the constipation group was much lower than that in the non-constipation group in the univariable analysis (72 h, 27% vs. 13%; 144 h, 31% vs. 21%). However, constipation was not associated with in-hospital mortality in the multivariable analysis (adjusted odds ratio: 0.91, 95% confidence interval: 0.64-1.30 and adjusted odds ratio: 1.14, 95% confidence interval: 0.70-1.85 at 72 and 144 h, respectively).
Constipation in critically ill patients was not associated with in-hospital mortality based on any definition of constipation used in previous studies. Further prospective studies are necessary to validate our findings.
危重症患者发生便秘的原因有多种。据报道，危重症患者便秘与不良结局相关。然而，目前尚缺乏关于便秘的统一定义，以及对存在便秘的危重症患者预后的报告。因此，我们旨在确定危重症期间便秘的流行病学，并根据之前研究中使用的两种便秘定义，评估便秘与院内死亡率之间的关系。
本回顾性队列研究纳入了 2011 年至 2018 年期间入住普通重症监护病房（ICU）的成年患者。我们检索了患者的排便信息，并根据之前的定义（72 小时和 144 小时未排便）评估了便秘对院内死亡率的影响。
在纳入的 1933 例成年 ICU 患者中，随着便秘持续时间的延长，便秘患者的比例逐渐降低（72 小时：67%，144 小时：36%）。在单变量分析中，便秘组的院内死亡率明显低于非便秘组（72 小时：27%比 13%；144 小时：31%比 21%）。然而，在多变量分析中，便秘与院内死亡率无关（调整后的优势比：0.91，95%置信区间：0.64-1.30 和调整后的优势比：1.14，95%置信区间：0.70-1.85，分别在 72 小时和 144 小时时）。
根据之前研究中使用的任何一种便秘定义，危重症患者的便秘与院内死亡率无关。需要进一步的前瞻性研究来验证我们的发现。
