Hay T, et al. - In this cluster-crossover trial, researchers compared the rate of rectal tube insertion (primary outcome) with major constipation- or diarrhea-associated complications related to the use of three prophylactic laxative regimens. In this study, three pods in a single intensive care unit were each randomized to one of three regimens for 4 months with rolling cross-over. They assigned all mechanically-ventilated and enterally-fed adult patients to either: one coloxyl with senna BD from day 1 (n=170), two coloxyl with senna with 20 mL lactulose BD commencing on day 3 n=205), or two coloxyl with senna tablets and 20 mL lactulose BD commencing on day 6 (n=195). The investigators did not detect any influence of earlier commencement of a prophylactic coloxyl-based laxative regimen (day 1 or 3) on the rates of complications related to constipation or diarrhea vs delayed introduction (day 6).