Constipation Bundle/Protocol and the Effect of Adherence in the Incidence of Constipation in Critically Ill Patients

"first 48 hours:~* polyethylene glycol 3350 (about 17 grams) 1 every 8 hours enterally.~* Patients who have vomiting and / or gastric residue greater than 500 mL (in a timely measurement every 6 hours) will also be given domperidone 10 mg every 8 hours intravenously.~* Patients who have excessive abdominal distension will be administered in addition, levosulpiride 25 mg every 8 hours intravenously.~ 48 hour evaluation:~* Patients who do not have bowel movements will be administered lactulose or sodium phosphate enema.~* For patients who do not have a bowel movement, administration of neostigmine intravenously or of naloxone enterally will be evaluated.~* Every patient who uses one or more prokinetics will have an electrocardiogram.~* Any patient who has bowel movements during management, doses of polyethylene glycol 3350 will be adjusted according to the daily goal of bowel movements, the days of treatment of the prokinetics will be adjusted, for a maximum of 5 consecutive days."

"Bundle of prevention:~* Start early enteral nutrition.~* Optimize and / or decrease opioid doses.~* Start early mobilization.~Non-pharmacological management bundle~* Select laxative and/or prokinetic/s to manage constipation.~* Optimize and / or decrease doses of opioids and sedatives.~* Start early mobilization.~* Pharmacological reconciliation."