A cluster double-crossover trial of early versus delayed aperient use in mechanically ventilated, enterally fed patients

Background

Aperient use in enterally fed, intubated, invasively mechanically ventilated intensive care unit (ICU) patients remains controversial and is associated with diarrhoea. The aim of this study was to assess whether the timing of aperient administration impacts the incidence and timing of diarrhoea and related complications in such patients.

Methods

We conducted a cluster, double-crossover, randomised trial in mechanically ventilated, enterally fed adults. We compared “delayed” aperient use (started on day 6 of enteral feeding) to “early” aperient use (started on day 1 of enteral feeding). The primary outcome was the occurrence of diarrhoea. Secondary outcomes included time until first defecation, rate of faecal management device insertion, rate of ileus, ICU length of stay, and mortality. Data were analysed using a Bayesian analysis.

Results

Of the 177 patients included, 42.4% in the delayed aperient group and 44.9% in early group developed diarrhoea (odds ratio: 0.91 [95% credible interval: 0.52 to 1.61]; probability of benefit: 62.4%). Diarrhoea, however, occurred later in patients in the delayed aperient group. Moreover, the occurrence of diarrhoea after day 6 was less in the delayed aperients group (21.2% vs. 44.9%; odds ratio: 0.37 [95% credible interval: 0.20 to 0.68]; probability of benefit: 99.9%). Other secondary outcomes including rate of ileus, ICU length of stay, and mortality did not show significant difference.

Conclusion

The timing of aperient administration did not impact the occurrence of diarrhoea or other patient-centred outcomes but delayed its onset. These findings suggest that delaying aperients has limited impact on diarrhoea.