Standardized Application of Laxatives and Physical Measures in Neurosurgical Intensive Care Patients Improves Defecation Pattern but Is Not Associated with Lower Intracranial Pressure

Table 1

SOP: promotility procedures for adult patients with acute severe brain disorder and expectable prolonged ventilation for more than 3 days.

	Procedures/promotility drugs
Day 1 = admission day	No procedures/drugs
Day 2	(i) Colon massage + physical therapy; (ii) Bisacodyl 10 mg supp. 1x/day; (iii) Lactulose 10 mL p.o. 2x/day; (iv) Clyster 50 mL 1x/day; (v) Sodium picosulfate 10 gtt p.o. 1x/day
Day 3	(i) Colon massage + physical therapy; (ii) Lactulose 10 mL p.o. 2x/day; (iii) Naloxone 4 mg p.o. 3x/day; (iv) Sodium picosulfate 20 gtt p.o. 1x/day; (v) Rhizine oil 20 mL p.o. 1x/day
Day 4	(i) Colon massage + physical therapy; (ii) Return-flow enema 1x/day; (iii) Lactulose 10 mL p.o. 2x/day; (iv) Naloxone 4 mg p.o. 3x/day; (v) Neostigmine-infusion 1.5 mg 0.25 mg/h i.v. 1x/day
Day 5	(i) Colon massage + physical therapy; (ii) Return-flow enema 1x/day; (iii) Lactulose 10 mL p.o. 2x/day; (iv) Naloxone 4 mg p.o. 3x/day; (v) Neostigmine-infusion 1.5 mg 0.25 mg/h i.v. 1x/day
Deescalation after adequate defecation to the following
(i) Lactulose 10 mL p.o. 2x/day (8:00 a.m. + 8:00 p.m.)
(ii) For opioid use: naloxone 4 mg p.o. 3x/day (8:00 a.m. + 4:00 p.m. + 12:00 p.m.)
(iii) Simethicone if necessary 5 mL p.o. 4x/day (2:00 a.m. + 8:00 a.m. + 2:00 p.m. + 8:00 p.m.)