Tao Heqing, Liu Ligang, Lu Weipeng, Ni Ziyan, Chen Xueqing, Nahata Milap C, Peng Liang
Department of Gastroenterology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
Institute of Therapeutic Innovations and Outcomes, College of Pharmacy, The Ohio State University, Columbus, OH 43210, USA.
Diseases. 2024 Nov 1;12(11):274. doi: 10.3390/diseases12110274.
: To investigate the effects of prophylactic use of stimulant laxatives and/or docusate on the clinical outcomes in critically ill patients who required mechanical ventilation (MV). : A single-center, retrospective, cohort study was conducted. Patients who received MV in the first 24 h after intensive care unit (ICU) admission were enrolled and divided into four groups: non-laxative, stimulant laxatives, docusate, and stimulant laxatives-docusate combination. The primary outcome was in-hospital mortality. The major secondary outcomes included ICU-free days and ventilator-free days at 28 days; the other outcomes were ventilation-associated pneumonia (VAP), enterobacterial infection, diarrhea, and electrolyte disturbances. Inverse probability treatment weighting (IPTW) was used to adjust for confounders. : A total of 2129 patients were included in this study, 263 of whom received stimulant laxatives, 253 received docusate, 368 received a combination, and 1245 did not receive any laxative. The prophylactic use of docusate was associated with a decreased risk of in-hospital mortality (OR: 0.59, 95% CI 0.42 to 0.83, = 0.002) and VAP (OR: 0.62, 95% CI 0.47 to 0.81, = 0.001). It was also associated with an increase in ICU-free days at 28 days (β: 0.89, 95% CI 0.83 to 0.95, < 0.001). Importantly, laxatives prophylaxis was not associated with increased risks of diarrhea, electrolyte disturbances, and enterobacterial infections. : Prophylactic use of docusate may improve certain prognoses and does not demonstrate any adverse events. However, further research is necessary to determine the optimal regimen and dosage of prophylactic laxatives in this specific population.
探讨预防性使用刺激性泻药和/或多库酯对需要机械通气（MV）的重症患者临床结局的影响。
进行一项单中心、回顾性队列研究。纳入重症监护病房（ICU）入院后24小时内接受MV的患者，并分为四组：未使用泻药组、刺激性泻药组、多库酯组和刺激性泻药-多库酯联合组。主要结局是住院死亡率。主要次要结局包括28天时无ICU天数和无呼吸机天数；其他结局为呼吸机相关性肺炎（VAP）、肠道细菌感染、腹泻和电解质紊乱。采用逆概率处理加权（IPTW）来调整混杂因素。
本研究共纳入2129例患者，其中263例接受刺激性泻药，253例接受多库酯，368例接受联合用药，1245例未接受任何泻药。预防性使用多库酯与降低住院死亡率风险（OR：0.59，95%CI 0.42至0.83，P = 0.002）和VAP风险（OR：0.62，95%CI 0.47至0.81，P = 0.001）相关。它还与28天时无ICU天数增加相关（β：0.89，95%CI 0.83至0.95，P < 0.001）。重要的是，泻药预防与腹泻、电解质紊乱和肠道细菌感染风险增加无关。
预防性使用多库酯可能改善某些预后且未显示任何不良事件。然而，需要进一步研究以确定该特定人群中预防性泻药的最佳方案和剂量。
