Thread by @WellingtonICU

This week's #Twitterjournalclub was prepared by @alexlin0528
It's the #HelpICUtrial (the hospital-based evaluation of laxative prophylaxis in ICU) which was published in the Journal of Critical Care 52 (2019) 86-91 doi.org/10.1016/j.jcrc…

570 adult mechanically ventilated and enterally fed patients were enrolled
Single ICU: cluster-crossover trial. Three pods in a single ICU each randomized to one of 3 regimens for 4 months with rolling crossover.

Participants were randomly allocated to:
A-One coloxyl with senna BD from day one, OR
B-Two coloxyl with senna + 20ml lactulose BD from day 3, OR
C-Two coloxyl with senna + 20ml lactulose BD from day 6

Primary outcome – Insertion of rectal tube or major constipation or diarrhoea associated complications
Secondary outcome - Diarrhoea or paralytic ileus or intestinal obstruction
Tertiary outcome - Duration of mechanical ventilation and 30-day mortality

Results
Primary outcome
Regime A – 12.9%
Regime B – 7.8%
Regime C - 7.7%
No statistically significant difference between groups
No statistically significant difference in secondary or tertiary outcomes

Overall 53/570 (9.3%) had a rectal tube inserted

Conclusion:
A delayed prophylactic laxative regime did not cause a statistically significant difference in rectal tube insertion rates or complications associated with constipation or diarrhoea.

side note from @dogicuma
it's not glamorous but much more work is needed in this area:

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