Early versus delayed aperient use in the intensive care unit

INTERVENTION: Early aperient use in which aperient administration commences at day 1 of enteral feed starting. The treatment is for one oral coloxyl with senna (Docusate sodium 50 mg / Sennosides 8 mg) tablet twice daily, starting the day that enteral nutrition was commenced and continued daily while enteral nutrition continues or until the development of diarrhoea while in the patient is in the intensive care unit. If no bowel action occurred by day 5 lactulose will be commenced at 20 ml twice daily via the nasogastic tube while the patient is in the intensive care unit. Medical record audit will be performed via members of the intensive care unit research team to monitor compliance. CONDITION: Bowel management in intensive care; ; Bowel management in intensive care Oral and Gastrointestinal ‐ Other diseases of the mouth, teeth, oesophagus, digestive system including liver and colon PRIMARY OUTCOME: Diarrhoea[Documented episodes of diarrhoea occurring during a patient's entire admission to the intensive care unit as recorded in the electronic medical record.] SECONDARY OUTCOME: 30‐day mortality[The mortality status of patients at 30‐day after admission to the intensive care unit as recorded in the electronic medical record.] Days admitted to hospital[Total number of days the patient is admitted to the hospital during their entire period of hospitalisation as recorded in the electronic medical record] Days admitted to the intensive care unit[Total number of days the patient is admitted to the intensive care unit during their the period of intensive care unit admission through until hospital discharge as recorded in the electronic medical record ] Days with diarrhoea[Documented days on which episodes of diarrhoea occur during a patient's entire admission to the intensive care unit as recorded in the electronic medical record.] Development of a bowel obstruction[Documented incidence of the development of a bowel obstruction occurring during a patient's entire admission to the intensive care unit as recorded in the electronic medical record.] Development of a paralytic ileus[Documented incidence of the development of a paralytic ileus occurring during a patient's entire admission to the intensive care unit as recorded in the electronic medical record.] ICD‐10 notation of constipation[Documented ICD‐10 coding of constipation as a complication that occurs during the period of intensive care unit admission through until hospital discharge as recorded in the electronic medical record.] Insertion of a bowel management device[Documented episodes of the insertion of a bowel management device as a result of within‐Intensive Care Unit diarrhoea occurring during a patient's entire admission to the intensive care unit as recorded in the electronic medical record.] INCLUSION CRITERIA: Adults aged equal to or greater than 18 years Mechanically ventilated at any stage during the intensive care unit admission Enterally fed via a feeding tube