Affiliations: Clinical and Administrative Sciences, Department of Pharmacy, College of Pharmacy, University of Oklahoma, Oklahoma City, OK, USA | Section of Pediatric Critical Care, Department of Pediatrics, College of Medicine, University of Oklahoma, Oklahoma City, OK, USA
Note:  Corresponding author: Peter N. Johnson, Pharm.D., BCPS, Associate Professor, Department of Pharmacy: Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, 1110 N, Stonewall Ave, CPB 206, Oklahoma City, OK, 73117 USA. Tel.: +1 405 271 2730; Fax: +1 405 271 6750; E-mail: [email protected]
Abstract: No studies have evaluated the outcomes of a bowel regimen (BR) in critically ill children receiving enteral nutrition. In fall 2010, a comprehensive feeding protocol and BR protocol were initiated in our institution. Six age-based BR protocols were developed, each of which included a four-step approach. This retrospective study evaluated children <18 years of age who received the BR between July 18, 2010 and April 31, 2012. The primary objective was to determine the percentage of patients requiring BR escalation beyond the initial step in the protocol (Step 1). Secondary objectives included the number of patients with a protocol deviation and the frequency of adverse events. Fifty-four patients were included. The majority were male with a median age of 0.25-year-old (range 0.08–15 yr). Forty-three (79.6%) patients received opioid continuous infusions. The BR was initiated on pediatric intensive care unit day 1 (range 1–25 d). Thirty patients (55.6%) required escalation beyond “Step 1”. All patients who received “Step 2” and “Step 3” had a protocol deviation. Opioid duration was significantly associated with protocol escalation (odds ratio, 0.83; 95% confidence interval 0.689–0.997; P = 0.047). This pilot study is the first to describe the outcomes of the implementation of a four-step BR in critically ill children. Future studies should focus on the optimal regimen to alleviate constipation in critically ill children.