Nasoenteric tube complications.

The use of nasoenteric tubes (NETs) is ubiquitous, and clinicians often take their placement, function, and maintenance for granted. NETs are used for gastrointestinal decompression, enteral feeding, medication administration, naso-biliary drainage, and specialized indications such as upper gastrointestinal bleeding. Morbidity associated with NETs is common, but frequently subtle, mandating high index of suspicion, clinical vigilance, and patient safety protocols. Common complications include sinusitis, sore throat and epistaxis. More serious complications include luminal perforation, pulmonary injury, aspiration, and intracranial placement. Frequent monitoring and continual re-review of the indications for continued use of any NET is prudent, including consideration of changing goals of care. This manuscript reviews NET-related complications and associated topics.

Death from adult respiratory distress syndrome and multiorgan failure following acute upper airway obstruction.

In adults with acute epiglottitis, transient noncardiogenic pulmonary edema may follow relief of upper airway obstruction, but typically does not progress to more severe pulmonary derangements. We describe a patient with post-obstructive pulmonary edema whose course was complicated by ARDS, multiorgan failure, and death. Recognition of UAO and expedient treatment depends heavily on the judgment and skills of the clinician and the available resources of the institution. Physicians caring for patients with AE should be aware of the potential for delayed morbidity and mortality following upper airway obstruction, even after establishing an adequate artificial airway. This case provides additional justification for aggressive airway management and intensive care support of patients with AE in order to avoid serious complications.

The pulmonary artery catheter: a diagnostic adjunct for fat embolism syndrome.

Available objective tests for fat embolism are neither sensitive nor specific. We performed frozen-section analysis of blood aspirated from a pulmonary artery catheter in a trauma victim with fat embolism syndrome and found marked levels of pulmonary microvascular blood fat. The amount of fat detected in this patient with long bone fractures was higher than that observed in a pilot study of this technique in cardiopulmonary bypass patients. This technique provided diagnostic support of our clinical findings. The procedure may prove useful in patients with an equivocal diagnosis of fat embolism or when the cause of posttraumatic acute pulmonary insufficiency is unknown.

Cytomegaloviral acalculous cholecystitis in acquired immunodeficiency syndrome patients.

Abdominal pain and fever in patients with the acquired immunodeficiency syndrome (AIDS) may indicate cytomegaloviral (CMV) acalculous cholecystitis. We reviewed clinical, laboratory, and outcome data from 12 patients with CMV cholecystitis. Ten of 12 patients were homosexual males. Six patients had markedly low CD4: CD8 lymphocyte count ratios. Total leukocyte counts were normal or decreased, serum liver function tests normal or cholestatic, and only one patient had hyperbilirubinemia. Sonographic transmural gallbladder edema is typically more severe than expected for the presenting illness. Five of six patients investigated with HIDA scintigraphy had a nonvisualizing gallbladder. Open cholecystectomy had a 9.1 per cent operative morbidity and a 0 per cent mortality. Cholecystectomy is a safe and curative intervention, regardless of the immunocompromised condition of the host. Intraoperative cholangiography will identify papillary stenosis or sclerotic bile ducts as a potential cause of recurrent symptoms following surgery. A search for other sites of tissue invasion by CMV should follow cholecystectomy.