Diarrhea in Mechanically Ventilated Patients: A Nested Multicenter Substudy
Bibliographic record
Abstract
OBJECTIVE: The aim of this study was to examine the prevalence and incidence of diarrhea, diarrhea risk factors, processes of care, and clinical outcomes associated with diarrhea in invasively ventilated patients in the ICU. DESIGN: Bedside nurses prospectively documented each patient's bowel movement (BM) using the Bristol Stool Chart type and number. Research Coordinators collected baseline and daily data evaluating risk factors for diarrhea and patient outcomes. The diarrhea definition was the World Health Organization definition of ≥3 loose or watery BMs (Bristol type 6 or 7) per day. We used Cox proportional hazards regression to evaluate risk factors and the association with the risk of death in the ICU. SETTING: Forty-four ICUs in Canada, the United States, and Saudi Arabia. PATIENTS: All 2,650 invasively ventilated critically ill patients were enrolled in this preplanned secondary analysis of a randomized trial that evaluated the probiotic Lactobacillus rhamnosus GG on infectious outcomes. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among 2,650 patients, the mean age (sd) was 59.8 (16.5) years, with an Acute Physiology and Chronic Health Evaluation II Score of 22.0 (7.8); 61.2% received inotropes/vasopressors on study day 1. Diarrhea occurred among 60.4% of patients and on 18.2% of ICU study days. Independent risk factors for diarrhea were a history of Clostridioides difficile infection, laxatives, and antibiotic use. Adjusted for these factors, enteral nutrition, particularly with moderate-high-protein content, also increased the risk of diarrhea. Univariable analysis suggested that diarrhea was associated with C. difficile testing, fecal management device insertion, and increased length of ICU and hospital stay. After adjusting for illness severity, mechanical ventilation, inotropes/vasopressors, renal replacement therapy, and severe infections, diarrhea was not associated with an increased risk of death. CONCLUSIONS: Diarrhea is common among invasively ventilated patients. Risk factors include a history of C. difficile, use of antibiotics, laxatives, and enteral nutrition, particularly moderate-high-protein composition feeds.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.010 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".