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COLORECTAL SURGERY

Put the coffee on

On the medical/surgical unit where I work, some surgeons encourage their post-op patients to drink coffee rather than tea or other beverages to help restore bowel motility. Does any recent evidence support this practice?-P.D., MD.

  
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Yes. A recently published study found that drinking coffee helps prevent post-op ileus (POI) following colorectal surgery, which is typically followed by transient POI lasting 3 to 5 days. Longer periods of POI are associated with more complications, such as delayed wound healing, atelectasis, and prolonged length of stay.

 

This prospective randomized controlled trial involved 115 patients who had undergone elective laparoscopic colorectal resection. Patients were randomly assigned to drink either coffee (n = 56) or tea (n = 59). Patients drank 150 mL of the assigned beverage three times per day every post-op day until discharge. The primary end point was time to first bowel movement. Secondary end points included the use of laxatives, insertion of a nasogastric tube, length of hospital stay, and post-op complications.

 

For patients in the coffee group, the first bowel movement occurred after a median of 65.2 hours versus 74.1 hours for those in the tea group. Length of hospital stay was also shorter in the coffee group (6 days versus 7 days). No significant differences were found in the other end points studied. The investigators concluded, "Because of its easy availability and low adverse effects, coffee could be integrated in the postoperative management of patients undergoing colorectal resections."

 

Source: Hasler-Gehrer S, Linecker M, Keerl A, et al. Does coffee intake reduce postoperative ileus after laparoscopic elective colorectal surgery? A prospective, randomized controlled study: the coffee study. Dis Colon Rectum. 2019;62(8):997-1004.

 

OTC PRODUCTS

This solution is no miracle

During medication reconciliation, a patient informed me that she occasionally consumes something called Miracle Mineral Solution as a health "tonic." I had never heard of this product. I doubt it is effective, but is it harmless?-N.M., WISC.

 

No. Miracle Mineral Solution (MMS) is promoted online as a cure-all for a wide range of disorders ranging from autism to influenza. It consists of 28% sodium chlorite in distilled water. Consumers are instructed to mix the sodium chlorite solution with citric acid (such as lemon or lime juice) or another acid before drinking. Some products are sold with a citric acid "activator." When the acid is added, the mixture becomes chlorine dioxide, a powerful industrial bleach.

 

The FDA recently warned consumers about reports of serious adverse reactions associated with MMS, including severe vomiting, severe diarrhea, and life-threatening hypotension. No scientific evidence supports the safety or effectiveness of MMS.1

 

MMS is marketed under other names, such as Master Mineral Solution, Miracle Mineral Supplement, Chlorine Dioxide Protocol, and Water Purification Solution. Warn patients that these products are dangerous. Anyone who has experienced an adverse reaction related to MMS is encouraged to report it to the FDA at http://www.fda.gov/medwatch/report.htm or by calling 800-FDA-1088.

 

REFERENCE

1. US Food and Drug Administration. FDA warns consumers about the dangerous and potentially life threatening side effects of Miracle Mineral Solution. News release. August 12, 2019. [Context Link]

 

ICU DELIRIUM

Can flexible visiting hours help prevent delirium?

Nurses in the ICU where I work are looking for ways to prevent ICU delirium in our patients. Because visiting hours in the ICU are fairly restrictive, we are considering adopting more flexible hours to increase family support. Is this a viable strategy?-D.S., N.M.

 

Although flexible visiting hours may have other benefits, a new study suggests that preventing delirium is not among them. To determine whether flexible visiting hours would reduce the incidence of delirium, investigators compared a policy that permits flexible family visitation (up to 12 hours per day) supported by family education with standard restricted visitation, which was defined by each ICU (median, 1.5 hours per day; up to 4.5 hours per day). The study involved 1,685 adult ICU patients. The primary outcome was incidence of delirium during the ICU stay. Secondary outcomes included ICU-acquired infections, symptoms of anxiety and depression, and burnout for ICU staff. Findings included the following:

 

* The incidence of delirium was about 19% in the flexible visitation group versus 20% in the standard restricted visitation group. This difference was not statistically significant.

 

* For family members in the flexible visitation group, median anxiety and depression scores were significantly better.

 

* No significant differences were found in the incidence of ICU-acquired infections or staff burnout.

 

 

The authors concluded, "Although flexible visitation resulted in increased presence of family members at the bedside and in higher perception of involvement in multiple strategies aimed to prevent delirium, such as reorientation, mobilization, and pain control, it was insufficient to prevent delirium."

 

Sources: Rosa RG, Falavigna M, da Silva DB, et al. Effect of flexible family visitation on delirium among patients in the intensive care unit: the ICU visits randomized clinical trial. JAMA. 2019;322(3):216-228. Flexible family visitation policy does not cut delirium in ICU. HealthDay News. July 16, 2019.