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Background: Although diarrhoea is a real source of morbidity for critically ill patients, this issue has been little studied, making it difficult to understand its mechanisms and management. Aims: We conducted a quality improvement study in an adult surgical intensive care unit before/after the implementation of a specific protocol to firstly improve diarrhoea management for patient benefit and secondly to understand the impact on caregivers. Study design: The first part of this before/after study consisted in assessing the proportion of patients receiving an anti‐diarrheal treatment before (phase I)/after (phase II) the implementation of the protocol. The second part of the study was to survey the caregivers on this topic. Results: Sixty four adults were included (33 in phase I; 31 in phase II) with 280 diarrheal episodes (129 in phase I; 151 in phase II). The proportion of patients who received at least one anti‐diarrheal treatment was similar between the two phases (79% (26/33) vs. 68% (21/31), p =.40). Diarrhoea incidence was also similar (9% (33 patients/368 admissions) vs. 11% (31 patients/275 admissions), p =.35). The delay to initiate at least one treatment was significantly shorter in phase II (2 days [1–7] vs. 0 day [0–2]; p <.001). The patients' rehabilitation was no longer impacted by the occurrence of a diarrheal episode in phase II (39% (13/33) vs. 0% (0/31), p <.001). Eighty team members completed the surveys in phase I and 70 in phase II. Caregivers perceived diarrhoea like a burden and its economic impact remained high. Conclusions: The implementation of a protocol for the management of ICU diarrhoea did not increase the proportion of patients treated, but it did significantly improve the delay to initiate a treatment. The patients' rehabilitation was no longer affected by diarrhoea. Relevance to clinical practice: The use of specific anti‐diarrhoea guidelines may help to reduce the burden of diarrhoea in an ICU. [ABSTRACT FROM AUTHOR]

Background: The benefit of a stay in an intensive care unit (ICU) is not certain for older patients, particularly in the surgical context. Aims: The objective of this study was to identify the factors associated with an unfavourable outcome in this population. Design: Prospective, descriptive, monocentric study conducted in the surgical ICU of a French university hospital. Methods: Patients aged ≥75 years admitted in the surgical ICU for a predicted length of stay ≥48 hours were included. Patients received an initial and a 6‐months nutritional and functional assessment performed by physicians and nurses. The outcome was considered as favourable if the Katz Activities of Daily Living (ADL) variation (ADL delta = 6‐months ADL – ICU admission ADL) was between 0 and −0.5 point 6 months after ICU discharge and unfavourable if the ADL delta decreased by more than 0.5 points or if the patient had died 6 months after ICU discharge. Results: Fifty‐six patients—32 (57%) male—aged 79 [77; 83] y were included. ICU mortality was 19%; 6‐month mortality was 22%. Median ADL delta was −0.5 [−0.5–0] points. A low ADL score (P =.0438) and a low albumin level (P =.0213) at admission were the two independent factors associated with an unfavourable outcome. Conclusion: Mortality and loss of independence were high in this elderly population during and after their surgical ICU stay. The benefit of a systematic collaboration between intensive care specialists, ICU nurses, and geriatricians, to assess and manage nutritional and functional problems and to prevent a pejorative outcome in patients over 75 years old admitted in surgical ICU needs to be studied. Relevance to clinical practice: There should be systematic screening for objective markers of undernutrition and frailty on ICU admission of older patients as they are associated with a poor prognosis. [ABSTRACT FROM AUTHOR]