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1.
Wiad Lek ; 74(1): 155-160, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33851607

RESUMO

Using the example of a clinical case, to present the management features of a patient with complete esophageal obliteration as a chemical burn result, the surgical intervention features in case of a non-standard situation during the operation, and the treatment results analyze. It was described a clinical case of 41-year-old patient with thoracic esophagus obliteration due to extended post-burn cicatricial esophageal stricture, dysphagia of IV degree in very severe general condition. Stamm-Senn-Kader's gastrostomy was performed as a first step of surgical treatment. Angiography and embolization of the right colic artery and it's branches was performed in 8 months while preserving the middle colic artery. In 20 days the cologastroanastomosis and feeding colostomy on the right chest wall were performed. In 10 days after the colostomy was disattached from the chest wall, the end-to-side esophagocoloanastomosis was performed intrapleurally. In one month after the third surgery and restoration of the food passage by the natural way, closure of the contact gastrostomy was performed. During the observation over the patient (8 years) the postoperative complications were not observed. The patient survived. The proposed staged surgical treatment tactics of patients with complete esophageal obliteration due to post-burn esophageal stricture, dysphagia of IV degree presents effective treatment results and a significant improvement in the patient's life quality.


Assuntos
Queimaduras Químicas , Estenose Esofágica , Adulto , Queimaduras Químicas/complicações , Queimaduras Químicas/cirurgia , Constrição Patológica , Estenose Esofágica/etiologia , Estenose Esofágica/cirurgia , Gastrostomia , Humanos
2.
Rev Fac Cien Med Univ Nac Cordoba ; 78(1): 45-47, 2021 03 24.
Artigo em Espanhol | MEDLINE | ID: mdl-33787025

RESUMO

Introduction: In critical ill patients, a hypermetabolic state develops in response to the aggression received, which leads to a rapid process of malnutrition, and has been associated with increased morbidity and mortality. The preferred enteral feeding way is through an endoscopic gastrostomy, an alternative procedure is the laparoscopic approach. Methods: Data was collected Between January 2016 and March 2019, of patients admitted to the Intensive Care Unit of the Hospital de Urgencias de Córdoba. Patients had an indication of enteral nutrition, and underwent laparoscopic feeding gastrostomy. Demographic data, as well as preoperative assessment according to the American Society of Anesthesiologists (ASA) classification, operative and postoperative complications, beginning and feasibility of feeding were recorded. Results: 12 patients full fill the inclusion criteria. Age average was 39 years. The total average surgical time was 39 minutes, not recording perioperative complications regarding the procedure. All the patients were fed after 24 hours. Conclusion: In our institution, the indication of percutaneous endoscopic gastrostomy is the elected choice; laparoscopic gastrostomy is a low-complexity technique, which can be done immediately after the indication in selected patients.


Assuntos
Laparoscopia , Traumatismo Múltiplo , Gastrostomia , Humanos , Estudos Retrospectivos
3.
Medicine (Baltimore) ; 100(10): e25029, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725885

RESUMO

ABSTRACT: The main purpose is to compare the efficacy of cystogastrostomy (CG) and Roux-en-Y-type cystojejunostomy (RCJ) in the treatment of pancreatic pseudocyst (PPC), and to explore the risk factors of recurrence and complications after internal drainage.Two hundred eight patients undergoing either CG or RCJ for PPC Between January 1, 2013and February 1, 2019, at West China Hospital of Sichuan University were retrospectively analyzed. The cure rate, complication rate and related factors were compared between the 2 groups.Two hundred eight patients with PPC underwent either a CG (n = 119) or RCJ (n = 89). The median follow-up time was 42.7 months. Between the 2 cohorts, there were no significant differences in cure rate, reoperation rate, and mortality (all P > .05). The operative time, estimated intraoperative blood loss, install the number of drainage tubes and total expenses in CG group were lower than those in RCJ group (all P < .05). The Logistic regression analysis showed that over twice of pancreatitis' occurrence was were independent risk factor for recurrence after internal drainage of PPC (OR 2.760, 95% CI 1.006∼7.571, P = .049). Short course of pancreatitis (OR 0.922, 95% CI 0.855∼0.994, P = .035), and RCJ (OR 2.319, 95% CI 1.033∼5.204, P = .041) were independent risk factors for complications after internal drainage of PPC.Both CG and RCJ are safe and effective surgical methods for treating PPC. There were no significant differences in cure rate, reoperation rate, and mortality between the 2 groups, while the CG group had a short operation time, less intraoperative bleeding and less cost.


Assuntos
Drenagem/métodos , Gastrostomia/métodos , Jejunostomia/métodos , Pseudocisto Pancreático/cirurgia , Pancreatite/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Anastomose em-Y de Roux/efeitos adversos , Perda Sanguínea Cirúrgica , Drenagem/efeitos adversos , Feminino , Gastrostomia/efeitos adversos , Humanos , Jejunostomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pseudocisto Pancreático/etiologia , Pseudocisto Pancreático/mortalidade , Pancreatite/complicações , Pancreatite/cirurgia , Complicações Pós-Operatórias/etiologia , Recidiva , Reoperação , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
4.
J Surg Res ; 259: 407-413, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33616074

RESUMO

BACKGROUND: Infants with congenital heart disease (CHD) may exhibit increased metabolic demands, and many will undergo placement of a gastrostomy to achieve adequate nutritional intake. There is a paucity of data, however, comparing the operative risks and overall complications of gastrostomy placement in cyanotic versus acyanotic infants with CHD. We hypothesized that patients with cyanotic CHD would have a higher rate of gastrostomy-associated complications than infants with acyanotic CHD. METHODS: We retrospectively reviewed patients who underwent gastrostomy button placement after cardiac surgery for CHD between 2013 and 2018. Patients were stratified into cyanotic CHD and acyanotic CHD cohorts. Patient data were extracted from the Society of Thoracic Surgeons database and merged with clinical data related to gastrostomy placement and complications from chart review. Unadjusted analyses were used to find covariates associated with cyanotic CHD and acyanotic CHD, using a t-test or Wilcoxon rank-sum test for continuous data, depending on normalcy, and χ2 or Fisher's exact tests for categorical data depending on the distribution. RESULTS: There were 257 infants with CHD who underwent gastrostomy placement during the study period, of which 86 had cyanotic CHD. There were no significant differences in baseline weight or preoperative albumin levels between the two groups. Patients with cyanotic CHD had a lower incidence of comorbid syndromes (P = 0.0001), higher Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery scores (P < 0.0001), and higher postoperative mortality rate (P = 0.0189). There was a higher rate of granulation tissue formation in patients with acyanotic CHD (48.5% versus 22.1%, P < 0.0001). There were no differences in other gastrostomy button-related complications, including leakage, wound infection, or dislodgement. CONCLUSIONS: Patients with acyanotic CHD demonstrated a higher incidence of granulation tissue. We found no difference in gastrostomy-specific complication rates between the two groups, with the notable exception of granulation tissue formation. Based on this study, the diagnosis of cyanotic CHD does not increase the risk of gastrostomy-related complications.


Assuntos
Cianose/terapia , Nutrição Enteral/efeitos adversos , Gastrostomia/efeitos adversos , Cardiopatias Congênitas/terapia , Intubação Gastrointestinal/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Comorbidade , Cianose/epidemiologia , Cianose/etiologia , Nutrição Enteral/métodos , Feminino , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Intubação Gastrointestinal/métodos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
5.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431464

RESUMO

An 81-year-old woman who underwent percutaneous endoscopic gastrostomy (PEG) a year before, after cerebral infarction was receiving home medical care. The first accidental PEG tube removal occurred after clinic hours, and the home-care doctor visited her home to quickly reinsert the tube. After the narrowed fistula was dilated, the tube was reinserted with a guide wire. An X-ray taken with a CALNEO Xair, which is an easily portable X-ray system launched in 2018, confirmed that the tip of the PEG tube was successfully placed in the stomach. A similar accidental removal occurred 2 months later, and we managed it in the same way. Both events were resolved with a single radiograph without significant difficulty. With in-home medical care, PEG tube replacement can be performed easily and safely with a handy portable X-ray system.


Assuntos
Remoção de Dispositivo , Nutrição Enteral/métodos , Gastrostomia/instrumentação , Serviços de Assistência Domiciliar , Radiografia/instrumentação , Idoso de 80 Anos ou mais , Feminino , Humanos , Estômago/diagnóstico por imagem
6.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509880

RESUMO

Anastomotic leakage (AL) occurs in 15% of cases of primary repair of oesophageal atresia. Urgent surgery is indicated in cases of complete anastomotic separation or severe mediastinitis. Otherwise, conservative management including keeping the patient nil per os (NPO), feeding via transanastomotic tube and prolonged parenteral nutrition, has been widely accepted as it can avoid multiple surgeries in neonates and allow oesophageal continuity to be preserved. However, complications relating to prolonged feeding tube use are common downsides to this approach and the negative impact of prolonged NPO on mastication and swallowing function cannot be ignored.In this case report, a novel approach for the treatment of AL with fibrin glue is reported, following primary repair of oesophageal atresia. It was endoscopically injected into the leakage site to enhance healing and early closure. This procedure was safely performed and achieved early establishment of oral feeding.


Assuntos
Fístula Anastomótica/terapia , Atresia Esofágica/cirurgia , Estenose Esofágica/cirurgia , Adesivo Tecidual de Fibrina/uso terapêutico , Adesivos Teciduais/uso terapêutico , Anastomose Cirúrgica , Síndrome de Down/complicações , Atresia Esofágica/complicações , Esofagoscopia/métodos , Feminino , Gastrostomia , Humanos , Lactente , Recém-Nascido , Complicações Pós-Operatórias/terapia , Diagnóstico Pré-Natal , Procedimentos Cirúrgicos Reconstrutivos/métodos
8.
J Clin Ultrasound ; 49(1): 28-32, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32681549

RESUMO

Critically ill patients often require gastrostomy tubes. Percutaneous endoscopic gastrostomy has become the most common method of placement but is not widely performed by critical care physicians, in part due to their lack of familiarity and training in upper gastrointestinal endoscopy. Percutaneous ultrasound gastrostomy (PUG) is a novel procedure for gastrostomy tube placement that utilizes ultrasound-based methods already familiar to critical care physicians. This technical note describes bedside PUG in the first five intensive care unit patients. All patients received timely gastrostomy placement, without complication, and were able to quickly achieve goal enteral nutrition.


Assuntos
Cuidados Críticos/métodos , Estado Terminal , Gastrostomia/métodos , Médicos , Cirurgia Assistida por Computador/métodos , Ultrassonografia/métodos , Adulto , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistemas Automatizados de Assistência Junto ao Leito
9.
Endoscopy ; 53(2): 178-195, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33348410

RESUMO

ESGE recommends the "pull" technique as the standard method for percutaneous endoscopic gastrostomy (PEG) placement.Strong recommendation, low quality evidence.ESGE recommends the direct percutaneous introducer ("push") technique for PEG placement in cases where the "pull" method is contraindicated, for example in severe esophageal stenosis or in patients with head and neck cancer (HNC) or esophageal cancer.Strong recommendation, low quality evidence.ESGE recommends the intravenous administration of a prophylactic single dose of a beta-lactam antibiotic (or appropriate alternative antibiotic, in the case of allergy) to decrease the risk of post-procedural wound infection.Strong recommendation, moderate quality evidence.ESGE recommends that inadvertent insertion of a nasogastric tube (NGT) into the respiratory tract should be considered a serious but avoidable adverse event (AE).Strong recommendation, low quality evidence.ESGE recommends that each institution should have a dedicated protocol to confirm correct positioning of NGTs placed "blindly" at the patient's bedside; this should include: radiography, pH testing of the aspirate, and end-tidal carbon dioxide monitoring, but not auscultation alone.Strong recommendation, low quality evidence.ESGE recommends confirmation of correct NGT placement by radiography in high-risk patients (intensive care unit [ICU] patients or those with altered consciousness or absent gag/cough reflex).Strong recommendation, low quality evidence.ESGE recommends that EN may be started within 3 - 4 hours after uncomplicated placement of a PEG or PEG-J.Strong recommendation, high quality evidence.ESGE recommends that daily tube mobilization (pushing inward) along with a loose position of the external PEG bumper (1 - 2 cm from the abdominal wall) could mitigate the risk of development of buried bumper syndrome.Strong recommendation, low quality evidence.


Assuntos
Nutrição Enteral , Gastrostomia , Adulto , Endoscopia Gastrointestinal , Gastrostomia/efeitos adversos , Humanos
10.
Support Care Cancer ; 29(1): 263-269, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32350670

RESUMO

BACKGROUND: Wax microsphere bound oxycodone was developed as an abuse-deterrent opioid and maintains a similar pharmacokinetic profile whether administered with or without an intact capsule. We hypothesized that microsphere oxycodone could be utilized for extended release analgesia in patients undergoing radiation (RT) for head-and-neck cancer (HNC) and would not need to be discontinued due to dysphagia or gastrostomy tube dependence. METHODS AND MATERIALS: We performed a prospective trial that enrolled participants > 18 years with histologically confirmed HNC who were scheduled to receive RT. Analgesia was prescribed in accordance with the WHO pain ladder. Microsphere oxycodone was initiated when total daily opioid dose exceeded 30 mg of morphine sulfate equivalent and was titrated weekly during RT. Pain level and effect on quality of life were assessed using the Brief Pain Inventory. The primary feasibility endpoint was frequency of microsphere oxycodone discontinuation within 3 months of RT for reasons other than pain resolution. RESULTS: Twenty-six eligible patients were enrolled. Microsphere oxycodone was initiated in 16 (61.5%) patients. Six (23.1%) patients utilized a gastrostomy tube to administer microsphere oxycodone during all or part of RT. Microsphere oxycodone was discontinued in 1 (7.6%) patient due to perceived inefficacy. No patients were discontinued due to toxicity or difficulty with administration. Ratings for average pain was 3.1 (± 3.4) at enrollment, 4.0 (± 2.4) at week 6 of RT, and 1.8 (± 2.2) at 3-month follow-up. CONCLUSIONS: These results support the feasibility and safety of microsphere oxycodone for extended release analgesia among patients with HNC undergoing RT.


Assuntos
Analgésicos Opioides/uso terapêutico , Neoplasias de Cabeça e Pescoço/radioterapia , Morfina/uso terapêutico , Oxicodona/uso terapêutico , Manejo da Dor/métodos , Dor/tratamento farmacológico , Analgesia , Transtornos de Deglutição , Preparações de Ação Retardada/uso terapêutico , Feminino , Gastrostomia , Humanos , Masculino , Microesferas , Pessoa de Meia-Idade , Mucosite/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Oxicodona/administração & dosagem , Estudos Prospectivos , Qualidade de Vida/psicologia
11.
A A Pract ; 14(14): e01371, 2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33350677

RESUMO

Respiratory failure in coronavirus disease 2019 (COVID-19) patients with prolonged endotracheal intubation may require a tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube placement to facilitate recovery. Both techniques are considered high-risk aerosol-generating procedures and present a heightened risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for operating room personnel. We designed, simulated, and implemented a portable, continuous negative pressure, operative field barrier system using standard equipment available in hospitals to enhance health care provider safety during high-risk aerosol-generating procedures.


Assuntos
/complicações , Endoscopia Gastrointestinal/métodos , Gastrostomia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Traqueostomia/métodos , Aerossóis , Pressão do Ar , Nutrição Enteral , Filtração , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Masculino , Pessoa de Meia-Idade , Salas Cirúrgicas , Isolamento de Pacientes
12.
Surg Clin North Am ; 100(6): 1091-1113, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33128882

RESUMO

Various approaches for enteral access exist, but because there is no single best approach it should be tailored to the needs of the patient. This article discusses the various enteral access techniques for nasoenteric tubes, gastrostomy, gastrojejunostomy, and direct jejunostomy as well as their indications, contraindications, and pitfalls. Also discussed is enteral access in altered anatomy. In addition, complications associated with these endoscopic techniques and how to either prevent or properly manage them are reviewed.


Assuntos
Endoscopia Gastrointestinal/métodos , Endoscopia Gastrointestinal/normas , Nutrição Enteral/métodos , Desnutrição/terapia , Competência Clínica , Endoscopia Gastrointestinal/educação , Gastrostomia/métodos , Gastrostomia/normas , Humanos , Intubação Gastrointestinal/métodos , Intubação Gastrointestinal/normas , Jejunostomia/métodos , Jejunostomia/normas , Desnutrição/cirurgia , Guias de Prática Clínica como Assunto
13.
Medicine (Baltimore) ; 99(43): e22903, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120842

RESUMO

Laparoscopic cholecystectomy is the routine method to treat gallbladder polyps. Nowadays, endoscopic ultrasound (EUS)-guided cholecystostomy as a bridge for per-oral transmural endoscopic resection of gallbladder polyps is introduced because preservation of gallbladder is increasingly getting attention. The aim of our study was to evaluate the approach in the treatment of patients with gallbladder polyps and symptomatic gallstones.EUS-guided cholecystostomy with the placement of a lumen-apposing metal stent (LAMS) was performed for those patients with accompanying gallbladder polyps and symptomatic gallstones. Several days after the cholecystostomy with LAMS, a gastroscope was introduced into the gallbladder to remove gallbladder polyps.All patients were successfully performed with the procedures of EUS-guided cholecystoduodenostomy (n = 3) or cholecystogastrostomy (n = 1) and endoscopic resection of gallbladder polyps. One patient experienced severe peritonitis. During the follow-up at 3 months, 1 patient was performed with laparoscopic cholecystectomy because ultrasonography examination showed the reappeared gallstones. No stone recurrence was found in other patients. During the follow-up of 3 to 15 months, no polyp recurrence was found in all the patients.The approach is novel for performing EUS-guided gallbladder fistulization, which can subsequently allow procedures of per-oral transmural endoscopic resection of gallbladder polyps to avoid cholecystectomy in the patients with gallbladder polyps and gallstones. However, further studies are needed before clinical recommendation because of the complications and stone recurrence.


Assuntos
Colecistostomia/métodos , Endossonografia/métodos , Vesícula Biliar/diagnóstico por imagem , Pólipos/cirurgia , Adulto , Anastomose Cirúrgica/métodos , Duodenostomia/métodos , Feminino , Seguimentos , Vesícula Biliar/patologia , Cálculos Biliares/cirurgia , Gastrostomia/métodos , Humanos , Masculino , Metais , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento , Ultrassonografia de Intervenção/instrumentação
14.
Neurol Neurochir Pol ; 54(5): 366-377, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33058114

RESUMO

The unfavourable outcome of amyotrophic lateral sclerosis (ALS) confronts patients with challenging decisions regarding life-sustaining measures. The decision-making process is usually triggered by medical consultations and patient-dependent factors. This may largely depend on the physician's depth of knowledge and professional experience. This paper presents an overview of the life-sustaining methods used in ALS and their effects on disease progression, survival and quality of life of patients and their caregivers. It is intended to aid physicians in their discussions with patients. We interrogate all the positive and negative facets of life-sustaining measures that may allow for optimisation of the decision-making process and care provision.


Assuntos
Esclerose Amiotrófica Lateral , Esclerose Amiotrófica Lateral/terapia , Progressão da Doença , Gastrostomia , Humanos , Qualidade de Vida , Respiração Artificial
16.
Rev. neurol. (Ed. impr.) ; 71(6): 213-220, 16 sept., 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-195514

RESUMO

INTRODUCCIÓN: Los problemas nutricionales son frecuentes en niños con enfermedades neurológicas, sobre todo si tienen una importante afectación motora. La disfagia orofaríngea es muy prevalente en estos pacientes y puede contribuir a empeorar el estado nutricional y a que se produzcan aspiraciones pulmonares. OBJETIVO: Evaluar de forma longitudinal el estado nutricional de una muestra de pacientes pediátricos con enfermedad neurológica moderada-grave y establecer la prevalencia de disfagia orofaríngea en dicha muestra. PACIENTES Y MÉTODOS: Estudio multicéntrico prospectivo observacional. Se incluyó a niños menores de 16 años controlados en cuatro centros hospitalarios. Se recogieron datos clínicos y antropométricos durante un año. Se realizaron preguntas dirigidas a realizar un cribado sistemático de disfagia orofaríngea. RESULTADOS: Se seleccionó a 68 pacientes, y el diagnóstico más frecuente fue la parálisis cerebral infantil. En la valoración antropométrica, 42 pacientes (62%) presentaron puntuaciones z de peso inferiores a 2, y 29 (43%), talla con puntuaciones z inferiores a 2, pero con un índice de masa corporal, un perímetro braquial y unos pliegues cutáneos mucho menos alterados. La prevalencia de disfagia orofaríngea fue del 73,5%, que aumentó a mayor afectación motora. CONCLUSIONES: Estos pacientes presentan un tamaño corporal menor que la población de su misma edad y sexo sin patología. Sin embargo, con un correcto seguimiento nutricional, mantienen estable su composición corporal. Es importante investigar de forma proactiva la presencia de disfagia orofaríngea, sobre todo en los que tienen mayor afectación motora, pues se presenta con mucha frecuencia y un adecuado diagnóstico puede mejorar la evolución clínica y prevenir complicaciones


INTRODUCTION: Nutritional problems are common in children with neurological diseases, especially if they have significant motor impairment. Oropharyngeal dysphagia is very prevalent in these patients, and can contribute to worsening nutritional status and produce pulmonary aspirations. AIM: Longitudinal assessment of the nutritional status of a sample of pediatric patients with moderate-severe neurological disease and establish the prevalence of oropharyngeal dysphagia in that sample. PATIENTS AND METHODS: An observational multicenter prospective study was conducted. We included children under 16 years of age with moderate-to-severe neurological impairment from four hospitals, with clinical and anthropometric monitoring for one year. Questions were asked to conduct oropharyngeal dysphagia screening. RESULTS: Sixty-eight children were included, the main diagnosis obtained was cerebral palsy. In the anthropometric assessment, 42 patients (62%) showed weight z scores below 2, and 29 (43%) height z scores below 2, while body mass index, mid upper arm circumference and triceps and subscapular skinfolds remained less affected. We found an oropharyngeal dysphagia prevalence of 73.5% in our sample, increasing with greater motor impairment. CONCLUSIONS: These patients showed lower weight and height than children without neurological impairment. However, with a correct follow-up they remain stable with an adequate body composition. It is important to proactively investigate the presence of oropharyngeal dysphagia, especially in those with greater motor impairment, as it occurs very frequently and an adequate diagnosis can improve clinical evolution and prevent complications


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Estado Nutricional/fisiologia , Transtornos de Deglutição/complicações , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/dietoterapia , Estudos Prospectivos , Antropometria/métodos , Transtornos de Deglutição/prevenção & controle , Gastrostomia
17.
Geriatr Gerontol Int ; 20(10): 961-966, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32812703

RESUMO

AIM: Studies of medication use in patients with a percutaneous endoscopic gastrostomy (PEG) tube have not been conducted adequately. The aim of this study was to describe medication use of care-dependent older adults with PEG and evaluate whether potential prescribing omissions (PPO) would affect the cause of death or acute illness. METHODS: In a geriatric long-term care hospital, 116 inpatients aged ≥65 years with insertion of a PEG tube because of dysphagia were enrolled and followed for 2 years: 2016-2018. The patients were divided into two groups, i.e., group A (who died between 2016 and 2018) and group B (who continued to be hospitalized in 2018). Clinical data and prescribed medications were recorded. Logistic regression models were conducted to assess the associations between survival and variables: age, gender, serum albumin level, serum creatinine level, body mass index (BMI), number of drugs and PPO. RESULTS: The patients' mean age was 85.3 ± 10.2 years, 57.8% were women and the mean number of drugs was 6.8 ± 3.5. Medications for managing symptoms, such as constipation and gastrointestinal symptoms, were commonly prescribed. The most common PPO medications were antiplatelet agents and anticoagulants. On logistic regression analysis, PPO had no influence on the cause of death or acute illness. Lower age, higher serum albumin level and body mass index were associated with survival in both univariate and multivariate models. CONCLUSIONS: Polypharmacy was prevalent in patients with PEG. Given the finding that PPO had no influence on health outcome, rational deprescribing could be warranted. Geriatr Gerontol Int 2020; 20: 961-966.


Assuntos
Causas de Morte , Desprescrições , Prescrições de Medicamentos/estatística & dados numéricos , Gastrostomia , Intubação Gastrointestinal , Idoso , Idoso de 80 Anos ou mais , Nutrição Enteral , Feminino , Humanos , Japão , Assistência de Longa Duração , Masculino , Polimedicação , Estudos Retrospectivos
18.
Respir Care ; 65(11): 1773-1783, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32759372

RESUMO

The COVID-19 pandemic has profoundly affected health care delivery worldwide. A small yet significant number of patients with respiratory failure will require prolonged mechanical ventilation while recovering from the viral-induced injury. The majority of reports thus far have focused on the epidemiology, clinical factors, and acute care of these patients, with less attention given to the recovery phase and care of those patients requiring extended time on mechanical ventilation. In this paper, we review the procedures and methods to safely care for patients with COVID-19 who require tracheostomy, gastrostomy, weaning from mechanical ventilation, and final decannulation. The guiding principles consist of modifications in the methods of airway care to safely prevent iatrogenesis and to promote safety in patients severely affected by COVID-19, including mitigation of aerosol generation to minimize risk for health care workers.


Assuntos
Infecções por Coronavirus , Remoção de Dispositivo/métodos , Gastrostomia , Controle de Infecções , Pandemias , Pneumonia Viral , Traqueostomia , Desmame do Respirador/métodos , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/cirurgia , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Cuidados Críticos/normas , Gastrostomia/instrumentação , Gastrostomia/métodos , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Controle de Infecções/normas , Pneumonia Viral/complicações , Pneumonia Viral/cirurgia , Pneumonia Viral/terapia , Respiração Artificial/métodos , Risco Ajustado , Traqueostomia/instrumentação , Traqueostomia/métodos
19.
Geriatr Gerontol Int ; 20(10): 932-937, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32857477

RESUMO

OBJECTIVES: Percutaneous endoscopic gastrostomy (PEG) is one of the methods of tube feeding in patients who are incapable of oral intake. There are no reports on risk factors for bleeding at PEG construction. Our main objective was to investigate the risks and predictors of bleeding associated with PEG construction. METHODS: This retrospective, observational study included patients who had undergone PEG construction at our institution. To investigate the risks of bleeding associated with PEG construction, we compared the baseline characteristics between bleeding and non-bleeding patients. In terms of early predictors of post-PEG bleeding, we evaluated whether there had been a decrease from baseline of >10% in hemoglobin levels on the day after the procedure. RESULTS: The median preoperative albumin levels were 22.5 g/L (range 20-29 g/L) and 30 g/L (range 18-40 g/L) in the bleeding and non-bleeding groups, respectively (P = 0.014, Mann-Whitney U-test). The median preoperative platelet counts were 177 500 (range 87 000-265 000) and 271 000 (83 000-749 000) in the bleeding and non-bleeding groups, respectively (P = 0.043, Mann-Whitney U-test). The number of patients for whom hemoglobin levels decreased >10% from baseline on the day after the procedure differed significantly between the bleeding and non-bleeding groups (2/4, 50% and 3/58, 5.45%), respectively (P = 0.002, Pearson's χ2 -test). CONCLUSIONS: Low serum albumin and preoperative platelet counts might be risk factors for bleeding. Rigorous follow up is necessary for patients showing a decrease in hemoglobin level ≥10% of their baseline the day after the procedure. Geriatr Gerontol Int 2020; 20: 932-937.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Nutrição Enteral , Gastrostomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Plaquetas/metabolismo , Feminino , Gastroscopia , Hemoglobinas/metabolismo , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica Humana/metabolismo , Adulto Jovem
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