TIRBO 55: Bowel regimens

The podcast addresses the pervasive yet often overlooked issue of bowel management in ICU patients. It highlights that nearly all ICU patients are at risk of constipation due to immobility, medications, and underlying conditions. The primary focus is on prophylactic approaches, particularly the use of polyethylene glycol (PEG), like Miralax, as a first-line treatment. The speaker suggests that PEG's advantage lies in its safety and the ability to increase the dosage until effective, even to bowel prep levels. While traditional regimens like Docusate and Senna are mentioned, the speaker notes the limited evidence supporting Docusate's efficacy. Alternative methods like suppositories, enemas, and manual disimpaction are reserved for specific cases of impaction or when upper GI access is limited.