Category: Critical Care
Keywords: diarrhea, ICU, mechanically ventilated (PubMed Search)
Posted: 8/4/2025 by Quincy Tran, MD, PhD
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Have you ever wondered what happened to your mechanically ventilated patients who developed diarrhea. Apparently, a multicenter study involving 2650 patients from 44 ICUs in the US, Canada and Saudi Arabia investigated the prevalence of diarrhea among these patients.
This study was the Editor’s choice for June 2025.
Results:
The mean age for the population was 59.8 (16.5) years, with APACHE II Score of 22.0 (7.8). Up to 61% of the patients received vasopressors or inotropes on day 1, which mean these patients are relatively ill.
Up to 60% of patients had diarrhea during their ICU stay, with 15% had diarrhea on day 1 or 2.
Initiating laxatives and antibiotics (who in the ICU would not receive vitamin V and Vitamin Z?) were associated with increased risk of diarrhea: HR for laxatives 1.28 (1.13–1.44), p<0.001; HR for antibiotics 1.41 (1.20–1.67), P< 0.001.
Furthermore, enteral feeding with high/moderate protein concentration was also associated with diarrhea (HR 1.13, 1.00-1.28, P=0.045.
Not surprisingly, diarrhea was associated with higher number of C. Diff testing.
Although patients with diarrhea were associated with longer ICU stay (15 [10-23] days) vs. those without diarrhea (8 [6-12] days), it was not associated with higher mortality (HR 0.70, 95% CI 0.57-0.86, P<0.001)
Discussion:
1. The authors did not report the rates of positive C. Diff. infection in these patients during ICU stay, although they did report that for another study in this population, the rate of positive C. Diff. infection during ICU stay was 2.2%. If only 2.2% had C. Diff. infection while up to 60% had diarrhea. Consequently, for every 30 patients with diarrhea, only one patient had C. Diff. infection. Therefore, do we have to check C. Diff. in those ICU patients with diarrhea every time?
2. The authors hypothesized that patients with diarrhea had longer ICU stay and lower mortality because they survived long enough to develop diarrhea. Thus, diarrhea is bad for clinicians, but may not be too bad for patients?
Conclusion:
Diarrhea is common among invasively ventilated patients. Patients who received laxatives, antibiotics, enteral feeding with high protein amount are at higher risk for diarrhea.
Dionne JC, Johnstone J, Heels-Ansdell D, Tahvildar Khazaneh P, Zytaruk N, Clarke F, Hand L, Millen T, Dechert W, Porteous R, Auld F, Hunt M, Campbell E, Bentall T, Campbell T, Smith O, Rose L, Arabi YM, Duan E, Wilcox ME, McIntyre L, Rochwerg B, Karachi T, Adhikari NK, Charbonney E, St-Arnaud C, Kristof A, Khwaja K, Marquis F, Zarychanski R, Golan E, Cook D; PROSPECT Research Coordinators Group, the PROSPECT Investigators and the Canadian Critical Care Trials Group. Diarrhea in Mechanically Ventilated Patients: A Nested Multicenter Substudy. Crit Care Med. 2025 Jun 1;53(6):e1247-e1256. doi: 10.1097/CCM.0000000000006667. Epub 2025 Apr 3. PMID: 40459385.
