Diarrhea during critical illness

Abstract

Diarrhea is common during critical illness; however, the etiology, definitions, incidence and risk factors for diarrhea and its impact on patient important outcomes require further investigation. There are many possible etiologies of diarrhea, including iatrogenic causes such as laxative medications, often administered as part of bowel protocols, as well as Clostriodiodes difficile associated diarrhea (CDAD). This thesis includes 6 chapters that address the knowledge gaps in the literature regarding the epidemiology of diarrhea in the intensive care unit (ICU), the impact of bowel protocols on diarrhea, and CDAD in critically ill adults. Chapter 1 provides an introduction to gaps in the literature that are addressed by the studies included in this thesis. Chapter 2 outlines the methodology used to inform the protocol for the Diarrhea, Incidence, Consequences and Epidemiology in the Intensive Care Unit (DICE-ICU) Study. Chapter 3 reports on the findings of DICE-ICU including the incidence, risk factors, definitions, and outcomes of patients who develop diarrhea in the ICU. Chapter 4 provides a content analysis of bowel protocols used in multiple ICUs. Chapter 5 summarizes a nested cohort study addressing the incidence, prevalence, timing, treatments, and outcomes of CDAD in critically ill patients enrolled in the PROSPECT Trial. Chapter 6 summarizes the work and discusses the strengths and limitations, implications and conclusions presented in this PhD thesis.