Factors Predicting Constipation in Critically Ill Patients

Main Article Content

ศิริพรรณ ภมรพล จารุณี นุ่มพูล

Abstract

Objective :To study factors that could predict constipation in critically ill patients.
Design : Descriptive predictive study.
Methodology : This study was conducted on 102 critically ill patients recruited by means of purposive sampling. The participants were at least 18 years old, and had been in the ICU for at least 4 days. Data were collected using 1) a personal information recording form; 2) a factor recording form; and 3) a constipation scale. Hierarchical regression was employed for data analysis.
Result: The patients’ intake of opioid analgesics, serum potassium levels, amounts of food intake through oesophagus, and amounts of physical activity were identifed as capable of jointly predicting up to 46% (R2 = .460) of instances of constipation. The most powerful predictive factor was the amounts of food intake through oesophagus (β = -.495, p < .01), followed by the intake of opioid analgesics (β = .214, p < .01) and amounts of physical activity (β= -.169, p < .05), respectively. The least powerful predictive factor was the level of serum potassium, on the other hand, was capable of predicting only the preliminary stage of constipation (β = -.261, p < .01). However, as no signifcant relationship between fluid balance and constipation was found.
Recommendation: It is recommended that nurses closely monitor constipation in patients having received opioid analgesics and in those with Hypokalemia. In addition, nurses should be prepared to feed the patients as soon as the patients are ready. Nurses are also advised to promote physical activity and bowel movement in the patients, to prevent constipation.

Keywords

Article Details

How to Cite
1.
ภมรพลศ, นุ่มพูลจ. Factors Predicting Constipation in Critically Ill Patients. Thai Journal of Nursing Council [Internet]. 8Feb.2019 [cited 13Nov.2019];34(1):88-03. Available from: https://www.tci-thaijo.org/index.php/TJONC/article/view/152511
Section
Research Reports

References

1. Bouras EP, Tangalos EG. Chronic constipation in the elderly. Gastroenterologic Clinical North America
2009; 38(3): 463-80.
2. Mostafa SM, Bhandari S, Ritchie G, Gratton N,Wenstone R. Constipation and its implications in the critically ill patient. Br J Anaesth 2003; 91(6): 815-9.
3. Ritchie G, Burgess L, Mostafa S, Wenstone R. Preventing constipation in critically ill patients. Nurs
Times 2008; 104(46): 42-4.
4. Putwatana P, Sanrung P, Budpanya W. Constipation, management, and clinical outcomes in critically ill surgical patients. Thai Journal of Nursing 2012;61(3): 60-8. (in Thai)
5. Asai T. Constipation: does it increase morbidity and mortality in critically ill patients. Crit Care Med 2007; 35(12): 2861-2.
6. Poompichet A. Fundamental in critical care. 2nd ed. Bangkok: Beyond enter price; 2014. (in Thai)
7. Btaiche IF, Chan LN, Pleva M, Kraft MD. Critical illness, gastrointestinal complications, and medication therapy during enteral feeding in critically ill adult patients. Nutr Clin Pract 2010; 25(1): 32-49.
8. American Gastroenterological Association. Understanding constipation [Internet]. 2013 [cited 2017 June 20]. Available from: http://www.gastro.org/patients-center/Understanding Constipation Brochure Jan 2013.pdf.
9. Nguyen T, Frenette AJ, Johanson C, Maclean RD, Patel R, Simpson A, et al. Impaired gastrointestinal transit and its associated morbidity in the intensive care unit. J Crit Care 2013; 28(4): 537. e11-7.
10. Spodniewska E, Guha A. Constipation in critically ill patients and its relationship to feeding and weaning form respiratory support. Crit Care 2013; 17(Suppl2): P241.
11. Gacouin A, Camus C, Gros A, Isslame S, Marque S, Lavoue S, et al. Constipation in long-term ventilated patients: associated factors and impact on intensive care unit outcome. Crit Care Med 2010; 38(10): 1933-8.
12. Poompichet A, Permpikul C. Critical care: towards optimal perfection. Bangkok: Beyond enter price; 2009. (in Thai)
13. Bennett M, Cresswell H. Factors influencing constipation in advanced cancer patients: a prospective study of opioid dose, dantron dose and physical functioning. Palliat Med 2003; 17(5): 418-22.
14. El-Saman SE-SA, El-Sayed Ahmed HH. Constipation occurrence among critical ill patients. IOSR-JNSH 2017; 6(2): 70-9.
15. Chen JZ, Deng AW, Xu JF. Electroenterogram manifestations and signifcance in hypokalemia. Di Yi Jun Yi Da Xue Xue Bao 2005; 25(1): 7-9.
16. McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, et al. The ASPEN board of directors; and the American College of Critical Care Medicine. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient. Journal of Parenteral and Enteral Nutrition 2009; 33(3): 277-316.103
17. Fukuda S, Miyauchi T, Fujita M, Oda Y, Todani M, Kawamura Y, et al. Risk factors for late defecation and its association with the outcomes of critically ill patients: a retrospective observational study. J Intensive Care 2016; 4: 33.
18. Nassar AP Jr, da Silva FM, de Cleva R. Constipation in intensive care unit: incidence and risk factors. J Crit Care 2009; 24(4): 630. e9-12.
19. Sharma SK, Kaur K, Garg R. Factors affecting bowel movement in critically ill patients. Nursing and Midwifery Research Journal 2007; 3(2): 71-8.
20. Towers AL, Burgio KL, Locher JL, Merkel IS, Safaeian M, Wald A. Constipation in the elderly: influence of dietary, psychological and physiological factors. J Am Geriatr Soc 1994; 42(7): 701-6.
21. Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomized controlled trial. Lancet 2002; 359(9320): 1812-8.
22. Panchal SJ, Muller-Schwefe P, Wurzelmann JI. Opioid-induced bowel dysfunction: prevalence, pathophysiology and burden. Int J Clin Pract 2007; 61(7): 1181-7.
23. Thomas J. Opioid-induced bowel dysfunction. J Pain Symptom Manage 2008; 35(1): 103-13.
24. Claure-Del Granado R, Mehta RL. Fluid overload in the ICU: evaluation and management. BMC Nephrol 2016; 17(1):109.
25. Phamornpon, S, Toskulkao T, Kimpee, S, Iramaneerat C. Factors predicting bowel function recovery in patients after open colorectal resection surgery. Journal of Thai Society of Therapuetic Radiology and Oncology 2013; 19(1): 38-46. (in Thai)
26. Behm B, Stollman N. Postoperative ileus: etiologies and interventions. Clin Gastroenterol Hepatol 2003; 1(2): 71-80.
27. Curtis CS, Kudsk KA. Enteral feedings in hospitalized patients: early versus delayed enteral nutrition. Pract Gastroenteral 2009; 33(10): 22-30.
28. Nakaji S, Tokunaga S, Sakamoto J, Todate M, Shimoyama T, Umeda T, Sugawara K. Relationship between lifestyle factors and defecation in a Japanese population. Eur J Nutr 2002; 41(6): 244-8.
29. K Bailes B, Reeve K. Constipation in older adults. Nurse Pract 2013; 38(8): 21-5.
30. Menids RJ, van Meegdenburg MM, Trzpis M, Broens PM. On the prevalence of constipation and fecal
incontinence, and their co-occurrence, in the Netherlands. Int J Colorectal Dis 2017; 32(4): 475-83.