Group Title: Critical Care
Title: Managing diarrhea and fecal incontinence: results of a prospective clinical study in the intensive care unit
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 Material Information
Title: Managing diarrhea and fecal incontinence: results of a prospective clinical study in the intensive care unit
Series Title: Critical Care
Physical Description: Archival
Creator: Gallagher,T.
Publication Date: 2005
General Note: Start pageP365
General Note: M3: 10.1186/cc3428
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Bibliographic ID: UF00100032
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: Open Access:
Resource Identifier: issn - 1364-8535


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Figure 1 (abstract P364)

(standard group n = 12). Blood samples were obtained for
lymphocyte subpopulations (NK, CD3, CD4, CD8, CD56, CD19,
CD25, CD69 and HLA-DR) at the beginning and at the fifth and
10th day after standard TPN. Flow cytometry analysis was
performed immediately. Nosocomial infections from entry to
discharge from the ICU were determined.
Results Baseline data (age, sex and severity score APACHE II)
were similar in the standard and glutamine groups. GLN-PN-
treated patients had less nosocomial infections (14 vs 25
nosocomial infectious episodes). The CD4/CD8 ratio showed an
increase from day 1 to day 5 in the GLN group. Mean lymphocyte
expression activation marker CD69 and HLA-DR are slightly
increased at day 5 in the standard group, while the later expression
lymphocyte activation marker CD25 is increased in the GLN group
(Fig. 1). The mortality in the ICU is increased in the standard group
(25 vs 12.5%).
Conclusions We conclude that in critically ill patients GLN-PN can
reduce the incidence of infectious complications and mortality.
This pilot study showed that the GLN-PN supplement improved
not only lymphocyte activation, but also regulatory mechanisms of
lymphocyte proliferation, illustrated by increased lymphocyte
expression surface marker CD25, compared with CD69 and HLA-
DR. This effect can apparently decrease nosocomial infections and
mortality in ICU patients.

Managing diarrhea and fecal incontinence: results of a
prospective clinical study in the intensive care unit

T Gallagher, J Wishin
University of Florida College of Medicine, Gainesville, FL, USA
Critical Care 2005, 9(Suppl 1):P365 (DOI 10.1186/cc3428)

Introduction Managing fecal incontinence and diarrhea challenges
ICU staff to control the fecal output and to protect the skin. This
diverts resources from other vital patient needs. A new medical
device system (FMS) was developed in which an inflated balloon
retains a tube within the rectum while an external pouch collects
fecal material, offering an option for temporary continence in
subjects with uncontrolled diarrhea.
Hypothesis Safety and performance of an innovative system
(FMS) for managing fecal incontinence was evaluated in a
prospective non-comparative study in two ICUs.
Methods Ten subjects with diarrhea and incontinence in two ICUs
had the FMS inserted. Endoscopic proctoscopies of the rectal
vault assessed the condition of the anorectal mucosa pre-insertion
and post-removal. Investigators assessed ease of FMS insertion
and removal, device retention and leakage, patient comfort,
perineal skin condition and presence or absence of odor during
FMS use.
Results The FMS device performed well during use for 1-13 days
with no safety issues among any of the 10 subjects, although two

died during the study due to non-product-related illnesses. It was
judged easy to insert and to remove with easy-to-follow
instructions. All subjects retained the device without difficulty or
external securing devices for the duration of the study, except one
with a weakened internal sphincter who expelled it after 8 hours.
During a total of 65 daily assessments, nurses reported the FMS
effective and time efficient in managing fecal incontinence, with no
odor or discomfort reported and limited leakage. During FMS use,
perineal and buttock skin condition was maintained or improved in
all but one patient who developed patchy redness on the buttocks.
Conclusions The FMS was well accepted, performed well, with no
safety issues, for all patients and helped reduce the risk of perineal
and buttock skin breakdown.

Luminal lactate and tyrosine release during intestinal ischemia
in rabbits

S Lobo, L Contrin, L Navegantes, S Orrico, M Queiroz, P Cury,
E Lira, A Carta, A Yamamoto, S Portella, J Vincent
Famerp Hospital de Base, Sao Jos6 do Rio Preto, Brazil
Critical Care 2005, 9(Suppl 1):P366 (DOI 10.1186/cc3429)

Introduction The intestinal tract plays a central role in the protein
catabolic response after injury and infection. Tyrosine (an index of
overall proteolysis) and lactate release were evaluated in luminal
gut perfusate during ligation of the superior mesenteric artery
(SMA). The aim of this study is to determine whether tyrosine flow
from the intracellular compartment to the lumen could occur during
ischemia-induced gut injury.
Methods Fourteen anesthetized New Zealand rabbits were
allocated into two groups (group I: control, n = 5 and group II:
ischemia, n = 9). SMA (QSMA) and aortic (Qaorta) flows were
measured using ultrasonic flow probes. A segment from the ileum
was isolated using two multilumen tubes with inflated balloons to
delimit a closed segment to be perfused. In a second gut segment,
a tonometric catheter (TRIP Tonometry Catheter; Datex, Finland)
was placed. Animals in group II were submitted to ligation of SMA
after baseline measurements. The concentrations of lactate and
tyrosine were determined in serum and gut luminal perfusate
(GLP). Tyronise was assayed by the fluorometric method as
previously described [1].
Results Lactate concentration significantly increased in GLP after
ligation of SMA (from 0.15 0.05 mEq/1 to 3.5 1.2 mEq/1 at
2 hours) in comparison with the control (from 0.18 0.43 mEq/1 to
0.22 0.12 mEq/1 at 2 hours) (P<0.05). Luminal tyrosine signifi-
cantly increased during ischemia compared with the control at
2 hours (from 11.9 8.9 mM/ml to 84 22 mM/ml, group II; and
from 6.9 2.9 mM/ml to 15.3 13.8 mM/ml, group I; P< 0.05).
Conclusion Ischemia rapidly induces gut-derived proteolysis in
1. Waalkes TP, Udenfriend S: A fluorometric method for the esti-
mation of tyrosine in plasma and tissues. J Lab Clin Med
1957, 50:733-736.

Abstract withdrawn.


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