Early versus delayed aperient use in the intensive care unit

Bowel management in the Intensive Care Unit is a generally overlooked issue. Both constipation and diarrhoea appear common in critical care patients. Their causes are multi-factorial and associated with adverse outcomes. In the intensive care unit at the Austin Hospital, two approaches to bowel management are typically used and are reflective of practice in other intensive care units worldwide. These two approaches are either an ‘early aperient use’ or a ‘delayed aperient use’ approach. However, the evidence to support either approach is not of high-quality. Thus, clinicians remain uncertain about which approach is best for critically ill patients. In response, we will perform a single-centre, cluster double crossover trial. We will include all adult patients (aged 18 years or older), who are receiving mechanical ventilation and are enterally fed via a feeding tube. Over a 12-month period, that includes four 3-month treatment periods, pods within the intensive care unit will be allocated to regimen of 'early aperient use' commencing on day 1 of admission or to a 'delayed aperient use' regimen commencing on day 6 of admission. We estimate that 880 patients will be included in the trial. Data collected for this trial will be that of standard routine care data extracted from electronic data sources. Research findings will be used to help reduce practice variation and may be used to inform the design and conduct of future ethically approved research in the area of bowel management for critically ill patients.