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1.
Am Surg ; 85(11): 1308-1309, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775976

RESUMO

We present a previously undescribed complication after noninvasive ventilation (NIV) for respiratory failure in a patient who required percutaneous endoscopic gastrostomy (PEG) tube placement for long-term nutrition after a complicated coronary bypass operation. A 54-year-old female diagnosed with unilateral vocal cord paralysis after emergent coronary artery bypass grafting (CABG) underwent an uncomplicated PEG tube placement. She was placed on intermittent NIV because of respiratory failure 24 hours after PEG placement, and NIV was continued for several days. Three days later, she was noted to have pneumoperitoneum on an upright chest X-ray. Abdominal CT scan revealed a large amount of pneumoperitoneum with the PEG tube in the correct position and no extravasation of enteric contrast from the stomach. Tube feeds were held and NIV was discontinued. Nonetheless, six days later, the patient was found on CT scan to have partial displacement of the PEG tube with leakage from the gastrotomy requiring operative repair. This case highlights the vulnerability of PEG tubes to management practices in the early postoperative period. Abdominal distention secondary to NIV likely caused pressure necrosis of the PEG site with dislodgement of the tube. This case elicits considerations regarding future management practices of patients receiving NIV in the early postoperative period after PEG placement.


Assuntos
Gastrostomia/efeitos adversos , Intubação Gastrointestinal , Ventilação não Invasiva/efeitos adversos , Pneumoperitônio/etiologia , Complicações Pós-Operatórias/etiologia , Ponte de Artéria Coronária/efeitos adversos , Feminino , Gastrostomia/instrumentação , Humanos , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/instrumentação , Pessoa de Meia-Idade , Pneumoperitônio/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/terapia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Tomografia Computadorizada por Raios X
2.
Br J Nurs ; 28(18): 1170-1174, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31597070

RESUMO

BACKGROUND: safe placement and securement of feeding tubes are essential to establishing early enteral nutrition. Nasogastric or nasojejunal feeding tubes are often inadvertently removed, and using a nasal bridle can reduce the number of tube replacements required. AIM: to review current nasal bridle practices on one intensive care unit. Over a 3-month period, nasal bridle use was recorded to measure unintentional tube loss and tube duration (the time a tube remained in situ). METHOD: an observational service evaluation. FINDINGS: 109 patients were recruited; 205 tubes were passed and 77 bridles were inserted, with 42% (n=46) of the bridles placed on day 1. Tubes secured with tape were more likely to be dislodged than tubes secured with a bridle, P=0.0001. Duration of tubes remaining in situ was significantly longer in patients who had a bridle fitted on day 1, P=0.0001 compared with tubes secured with tape. CONCLUSION: securing a tube with a nasal bridle from day 1 is independently associated with reduced tube loss, increased duration of tube use, and likelihood that the tube would reach redundancy when it was no longer required.


Assuntos
Nutrição Enteral/instrumentação , Falha de Equipamento/estatística & dados numéricos , Unidades de Terapia Intensiva , Intubação Gastrointestinal/instrumentação , Nutrição Enteral/métodos , Humanos , Intubação Gastrointestinal/métodos
3.
J Cardiothorac Surg ; 14(1): 146, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31362772

RESUMO

BACKGROUND: A clinical case-control study was conducted to analyze the short-term efficacy of modified gastric tube in surgery for middle (mid)- and lower- thoracic esophageal carcinoma compared with the conventional gastric tube and its effect on postoperative pulmonary function. METHODS: A total of 70 patients with mid- and lower-thoracic esophageal cancer who underwent esophagectomy between October 2012 and September 2018 in our hospital were recruited in the study. They were randomly divided into a modified gastric tube group (n = 35) and a conventional gastric tube group (n = 35). The operation time, intraoperative blood loss, number of intraoperative lymph node dissection, gastrointestinal decompression time and postoperative hospital stay were recorded. The operation results and complications were recorded, and the pulmonary function was recorded at 3 days before surgery and 6 weeks after surgery. RESULTS: The operation time in the modified gastric tube group was significantly lower than that in the gastric tube group (P < 0.05). There were no anastomotic leakage or death occurred in the modified gastric tube group. There was 1 case of anastomotic leakage in the conventional gastric tube group. The pulmonary function in both groups was improved at 6 weeks after surgery, but there was no significant difference between both groups (P > 0.05). CONCLUSION: Modified gastric tube has a good clinical application value compared with gastric tube for patients with mid- and lower-thoracic esophageal cancer. It is easy and safe, and can shorten the operation time without aggravation of pulmonary function after surgery.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias Esofágicas/cirurgia , Intubação Gastrointestinal/instrumentação , Adulto , Idoso , Fístula Anastomótica/epidemiologia , Estudos de Casos e Controles , Desenho de Equipamento , Esofagectomia/métodos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
5.
BMJ Case Rep ; 12(6)2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31189546

RESUMO

A 55-year-old woman developed a postoperative ileus with associated nausea and vomiting following an elective laparotomy. A wide bore nasogastric (NG) tube was inserted for gastric decompression and symptom relief. Aspiration of the tube was unsuccessful and the patient continued to vomit. Imaging to investigate the acute abdomen demonstrated the nasogastric tube to be correctly sited and within pooled gastric contents. Gentle initial attempts were made to unblock the NG but to no avail and therefore it was removed. On inspection it was discovered that the NG tube had no distal perforations to allow drainage, causing failure and increasing the patient's risk of aspiration. The aim of this report is draw attention to the importance of scrutinising all medical equipment prior to use to prevent avoidable and potentially serious patient harm.


Assuntos
Descompressão Cirúrgica/métodos , Nutrição Enteral/efeitos adversos , Íleus/cirurgia , Intubação Gastrointestinal/instrumentação , Complicações Pós-Operatórias/cirurgia , Feminino , Humanos , Íleus/etiologia , Laparotomia/efeitos adversos , Pessoa de Meia-Idade , Náusea/etiologia , Náusea/cirurgia , Complicações Pós-Operatórias/etiologia , Falha de Prótese , Vômito/etiologia , Vômito/cirurgia
6.
Nutr. hosp ; 36(3): 504-509, mayo-jun. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184545

RESUMO

Introduction: accidental dislodgement of enteral feeding tubes has been considered as an important quality indicator of the efficacy of enteral nutrition therapy. However, in clinical practice, the use of feeding tube attachment devices (FTADs), as an alternative to the traditional method of adhesive tape alone, has not yet been evaluated for its effectiveness in reducing inadvertent tube dislodgement. Objective: to evaluate the impact of using a dedicated FTAD compared with the traditional securing method with adhesive tape on the occurrence of accidental enteral feeding tube removal. Methods: a randomized clinical trial comparing two strategies for enteral feeding tube securement: use of traditional adhesive tape vs FTAD. The primary endpoint was the percentage of accidental enteral feeding tube dislodgement after randomization. Results: a total of 104 inpatients (mean age: 61.4?±?17.5 years) were included (52 patients per group). Most were women with cerebrovascular disease (35.6%), diabetes (28.8%) and neoplasia (27.9%). There were 39 (37.5%) cases of accidental tube removal, 30.8% in the FTAD group and 44.2% in the adhesive tape group (p?=?0.22). During follow-up, patients in the FTAD group received a mean of 60.0% of the volume of enteral nutrition prescribed, while patients in the adhesive tape group received 57.0% (p?=?0.61). There was no difference in skin lesions between the groups. Conclusion: the strategy of using a dedicated FTAD as the method for securing enteral feeding tubes did not reduce the risk of accidental tube dislodgement compared with the traditional securing method with adhesive tape


Introducción: la expulsión accidental de sondas de alimentación enteral se ha considerado un indicador importante de la calidad de la eficacia de la terapia de nutrición enteral. Sin embargo, en la práctica clínica, el uso de dispositivos de fijación de tubos de alimentación (FTAD, por sus siglas en inglés), como una alternativa al método tradicional de cinta adhesiva exclusivamente, aún no se ha evaluado por su eficacia para reducir el desprendimiento accidental de sondas. Objetivo: evaluar el impacto de usar un FTAD dedicado en comparación con el método tradicional de aseguramiento con cinta adhesiva en caso de que se produzca una extracción accidental de la sonda de alimentación enteral. Métodos: se realizó un ensayo clínico aleatorizado que comparó dos estrategias para asegurar la sonda de alimentación enteral: el uso de cinta adhesiva tradicional frente a FTAD. El punto final primario fue el porcentaje de desplazamiento accidental del tubo de alimentación enteral después de la aleatorización. Resultados: se incluyó un total de 104 pacientes hospitalizados (edad media 61,4 ± 17,5 años) (52 pacientes por grupo). La mayoría eran mujeres con enfermedad cerebrovascular (35,6%), diabetes (28,8%) y neoplasia (27,9%). Hubo 39 casos (37.5%) de extracción accidental de tubos, 30,8% en el grupo FTAD y 44,2% en el grupo de cinta adhesiva (p = 0,22). Durante el seguimiento, los pacientes del grupo FTAD recibieron una media del 60,0% del volumen de nutrición enteral prescrito, mientras que los pacientes del grupo de cinta adhesiva recibieron el 57,0% (p = 0,61). No hubo diferencia en las lesiones de la piel entre los grupos. Conclusión: la estrategia de utilizar un FTAD dedicado como método para asegurar las sondas de alimentación enteral no redujo el riesgo de retiradas accidentales en comparación con el método tradicional de sujeción con cinta adhesiva


Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Nutrição Enteral/instrumentação , Intubação Gastrointestinal/instrumentação , Terapia Nutricional/métodos , Intubação Gastrointestinal/métodos , Qualidade da Assistência à Saúde , Modelos Logísticos
7.
Acta Oncol ; 58(8): 1187-1196, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31032694

RESUMO

Background: Prior reports have raised concerns that a prophylactic gastrostomy may be detrimental to long-term swallow function. This study evaluates patient-reported swallow function following chemoradiotherapy for oropharyngeal carcinoma in relation to the use of a prophylactic gastrostomy or nasogastric (NG) tube as required. Material and methods: The MD Anderson Dysphagia Inventory (MDADI) was posted to 204 disease-free patients at least 2 years following chemoradiotherapy for oropharyngeal carcinoma between 2010 and 2014. Results: Overall, 181/204 (89%) patients returned questionnaire at a median of 34 months post-treatment. 97/181 (54%) and 84/181 (46%) were managed with an approach of a prophylactic gastrostomy or NG tube as required, respectively. A prophylactic gastrostomy was associated with higher rates of enteral feeding (92% vs. 58%, p < .001), lower median percentage weight loss (7.0% vs. 9.4%, p < .001), increased duration of enteral feed (median 3.3 vs. 1.1 months, p < .001). There was no significant difference in patient-reported swallow function measured by MDADI summary scores and subscales for patients managed with an approach of prophylactic gastrostomy or NG as required. Duration of enteral feed correlated negatively with composite MDADI scores. A subgroup of 116/181 (64%) patients were documented as having been offered a choice of enteral feeding approach and therefore can be considered to represent clinical equipoise; there were no significant differences in MDADI scores according to route. Conclusions: Despite concern regarding the use of a prophylactic gastrostomy in prior studies, the approaches of using a prophylactic gastrostomy or an NG tube as required to support patients during/after chemoradiotherapy for oropharyngeal carcinoma were associated with similar long-term swallow outcomes.


Assuntos
Carcinoma/terapia , Quimiorradioterapia/efeitos adversos , Transtornos de Deglutição/epidemiologia , Nutrição Enteral/efeitos adversos , Intubação Gastrointestinal/efeitos adversos , Neoplasias Orofaríngeas/terapia , Adulto , Idoso , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Nutrição Enteral/instrumentação , Nutrição Enteral/métodos , Feminino , Seguimentos , Gastrostomia/efeitos adversos , Humanos , Intubação Gastrointestinal/instrumentação , Intubação Gastrointestinal/métodos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
8.
J Pediatr Surg ; 54(5): 1041-1044, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30819544

RESUMO

BACKGROUND: Gastrojejunostomy tubes (GJTs) have been associated with intestinal perforation in children <6 months or <6 kg. This study evaluated the impact of an institutional practice change recommending a new soft tip GJT for children <10 kg. METHODS: We performed a single-center review of GJT placements among children <10 kg before (1/1/2010-12/31/2013) and after (7/1/2014-12/31/2016) the practice change. Intestinal perforation, nasojejunal tube (NJT) for >30 days, and GJT replacement were assessed. RESULTS: Sixty GJTs were placed in 35 children (54% male; 17.2±9.0 months old) after compared to 147 GJTs in 77 children (44% male, p=0.32; 14.1±11.8 months, p=0.08) before the practice change. Use of soft tip GJT was adhered to in 19 placements (32%). There were no intestinal perforations after the practice change (before: 6 (4.1%); p=0.11). NJT remained >30 days in 15 patients (65%) after the practice change (before: 13 (35%); p=0.02). Replacement was required for 53% with soft tip GJT and 18% with standard GJT (p=0.006). DISCUSSION: A reduction in intestinal perforation with an institutional practice change may be explained by fewer GJT placements in high-risk children and longer length of NJT placement. Future protocols may consider age and size restrictions rather than alternative tube types. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: Level III.


Assuntos
Derivação Gástrica , Perfuração Intestinal/etiologia , Intubação Gastrointestinal , Pré-Escolar , Desenho de Equipamento , Feminino , Derivação Gástrica/efeitos adversos , Derivação Gástrica/instrumentação , Derivação Gástrica/estatística & dados numéricos , Humanos , Lactente , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/instrumentação , Intubação Gastrointestinal/estatística & dados numéricos , Masculino , Estudos Retrospectivos
10.
Int J Nurs Stud ; 92: 73-78, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30743198

RESUMO

BACKGROUND: Distance from the tip of the nose to earlobe to xiphisternum is commonly used to determine the length of nasogastric tube to be inserted. However, it is not evidence-based and frequently leads to improper positioning. OBJECTIVES: This study evaluated four formulae and the distance from the tip of the nose to earlobe to xiphisternum in estimating the internal length of nasogastric tube required for optimal positioning. DESIGN: Observational Study. SETTINGS: Tertiary hospital in Singapore involving patients from the medical and surgical intensive care units and a neurosurgical ward. PARTICIPANTS: Inclusion criteria were patients who required a nasogastric tube insertion and age > = 21 years old and =<85 years old. Patients who required an orogastric tube insertion or did not require a chest x-ray post nasogastric tube insertion were excluded. METHODS: Upon nasogastric tube insertion, the external length of the tube was measured and the corresponding internal length calculated. Several anatomical measurements were taken as required in the formulae below: 1. ((Distance from tip of nose to earlobe to xiphisternum-50 cm)/2) + 50 cm. 2. 29.38 + 4.53*gender+0.34*distance from nose to umbilicus with head flat on bed-0.06*weight (gender = 1 for male, and 0 for female). 3. Distance from xiphisternum to earlobe to nose + 10 cm. 4. Distance from earlobe to xiphisternum to umbilicus-distance from tip of the nose to earlobe. Post insertion chest x-rays were examined to evaluate the position of the nasogastric tube. For those with optimal positioning, the distance from tip of the nose to earlobe to xiphisternum and the four formulae were compared to determine which provided the least difference with the internal length of the nasogastric tube. RESULTS: Ninety-two participants were recruited. The average age of the cohort was 62.9 years old with 54% being male. Twenty-five had nasogastric tubes in optimal position; 13 had it too short and 54 had it too long. For nasogastric tubes in optimal position, distance from xiphisternum to earlobe to nose + 10 cm provided the best estimate of the internal length. Average difference between the distance from xiphisternum to earlobe to nose + 10 cm and internal length of the nasogastric tubes in optimal position was only 1.8 cm which was by far the least difference compared to other formulae. CONCLUSION: This study found distance from xiphisternum to earlobe to nose + 10 cm to provide the best estimate for the internal length of nasogastric tube required. However, even this formula could result in placement that is not optimal due to anatomical differences.


Assuntos
Intubação Gastrointestinal/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Antropometria , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Singapura , Adulto Jovem
11.
Am J Case Rep ; 20: 224-227, 2019 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-30783075

RESUMO

BACKGROUND Intramural hematoma of the esophagus (IHE), a rare manifestation of acute mucosal injuries of the esophagus, can be caused by trauma such as endoscopic surgeries. Coagulation disorders increase the risk of IHE. The most common location of IHE is in the distal esophagus. The characteristic clinical triad of manifestations comprises acute retrosternal pain, odynophagia or dysphagia, and hematemesis. It is important to distinguish IHE from other acute conditions such as acute coronary syndrome, aortic dissection, and pulmonary embolism. CASE REPORT An 84-year-old male was scheduled for coil embolization for an endoleak after endovascular aneurysm repair. For this reason, he was taking aspirin and warfarin. A nasogastric tube had been inserted during surgery and subsequently removed without any problems reported. Postoperatively, he experienced chest pain and hematemesis of sudden onset. Urgent esophagogastroduodenoscopy demonstrated a large, dark red, non-pulsatile, submucosal, esophageal mass in the area of the mid-esophagus with a little oozing. He was diagnosed as having an IHE; other possible diagnoses were excluded by contrast-enhanced computed tomography and aortography. He was treated with fasting, a proton pump inhibitor, and cessation of anti-thrombotic drugs; he recovered completely. The bleeding spot in the esophagus was in the area of the mid-esophagus, which was around the second natural constriction site. It was possible that the nasogastric tube had contact with the esophageal wall at this second natural constriction, and caused intramural esophageal bleeding. CONCLUSIONS Nasogastric tubes are not generally recognized as a cause of IHE. However, they can cause them, especially when a patient is taking anti-thrombotic drugs.


Assuntos
Doenças do Esôfago/etiologia , Hematoma/etiologia , Intubação Gastrointestinal/efeitos adversos , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Aspirina/uso terapêutico , Humanos , Intubação Gastrointestinal/instrumentação , Masculino , Inibidores da Agregação de Plaquetas/uso terapêutico , Varfarina/uso terapêutico
12.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(1): 79-84, 2019 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-30703798

RESUMO

OBJECTIVE: To establish a modified endoscopic Freka Trelumina placement (mEFTP) for modifying or substituting the traditional endoscopic Freka Trelumina placement (EFTP) and to explore the safety and feasibility of mEFTP in patients requiring enteral nutrition and gastrointestinal decompression in general surgery. METHODS: A retrospective cohort study was conducted to analyze the clinical data of patients undergoing EFTP or mEFTP at General Surgery Department of 920 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from January 2016 to January 2018. INCLUSION CRITERIA: the function of lower digestive tract was normal; patients who could not eat through mouth or nasogastric tube needed to have enteral nutrition and gastrointestinal decompression; the retention time of Freka Trelumina (FT) was not expected to exceed 2 months. EXCLUSION CRITERIA: contraindication for gastroscopy; suspected shock or digestive tract perforation; suspected mental diseases; infectious diseases of digestive tract; thoracoabdominal aortic aneurysm. mEFIP procedure was as follow. FT was inserted into stomach through one side nasal cavity, gastroscope was inserted into stomach cavity, and the front part of FT was clamped with biopsy forceps through biopsy hole. Biopsy forceps and FT were inserted into the pylorus or anastomosis under gastroscope, and they were pushed into the duodenum or output loop. During pushing, the gastroscope did not pass through the duodenum or output loop. The biopsy forceps was released and pushed out, and FT was pushed with biopsy forceps synchronously into the duodenum or output loop more than 5 cm. The foreign body forceps was inserted through the biopsy hole, and the FT tube was held in the stomach and pushed to the duodenum or output loop. The previous steps repeated until the suction cavity reached the pylorus or anastomosis. The gastroscope was exited gently; the guide wire was pulled out slowly. EFTP procedure: foreign body forceps was used to clamp the front part of FT, and gastroscope, foreign body forceps and FT pass the pylorus or anastomosis simultaneously to reach the descendent duodenum or output loop as a whole. The time of catheterization was recorded and position of FT was examined by X-ray within 1 h after catheterization. The success rate of catheterization and morbidity of complications after catheterization were evaluated and compared between the two groups. RESULTS: A total of 141 patients were enrolled, 72 in the mEFTP group and 69 in the EFTP group. In mEFTP group, 45 cases were males and 27 were females with an average age of 55.8(37-76) years; 27 cases had normal upper gastrointestinal anatomy (postoperative gastroplegia syndrome due to colon cancer in 17 cases, due to rectal cancer in 10 cases) and 45 had upper gastrointestinal anatomic changes (gastric cancer with pylorus obstruction in 18 cases and anastomotic block after gastroenterostomy in 27 cases). In the EFTP group, 41 were males and 28 were females with an average age of 55.3(36-79) years; 33 cases had normal upper gastrointestinal anatomy (postoperative gastroplegia syndrome due to colon cancer in 20 cases, due to rectal cancer in 13 cases) and 36 had upper gastrointestinal anatomic changes (gastric cancer with pylorus obstruction in 15 cases and anastomotic block after gastroenterostomy in 21 cases). In patients with normal upper digestive tract anatomy, the average catheterization time of mEFTP was (4.9±1.7) minutes which was shorter than (7.6±1.7) minutes of EFTP(t=6.683, P<0.001). In patients of gastric cancer with pyloric obstruction, the average catheterization time of mEFTP was (6.6±1.6) minutes which was shorter than (10.5±2.6) minutes of EFTP (t=4.724, P<0.001). In patients with anastomotic block after gastroenterostomy, the average catheterization time of mEFTP was (11.3±2.5) minutes which was shorter than (15.1±3.5) minutes of EFTP (t=4.513, P<0.001). In patients with normal upper gastrointestinal anatomy, there were no significant differences in the success rate of catheterization and the morbidity of catheterization complication between mEFTP and EFTP (all P>0.05). In patients with upper gastrointestinal anatomic changes, the success rate of catheterization in mEFTP was even higher than that in EFTP, but the difference was not significant [97.8%(41/45) vs. 86.1%(31/36), χ²=2.880, P=0.089]; while the morbidity of catheterization complication in mEFTP was lower than that in EFTP [0 vs. 8.3%(3/36), χ²=3.894, P=0.048]. CONCLUSIONS: Whether the upper gastrointestinal anatomy is normal or not, mEFTP presents shorter catheterization time, higher success catheterization rate than EFTP, and is safety. mEFTP can be widely applied to clinical practice for patients requiring enteral nutrition and gastrointestinal decompression.


Assuntos
Descompressão Cirúrgica/instrumentação , Nutrição Enteral/instrumentação , Gastroscopia/instrumentação , Intubação Gastrointestinal/instrumentação , Intubação Gastrointestinal/métodos , Gastropatias/cirurgia , Adulto , Idoso , Descompressão Cirúrgica/métodos , Nutrição Enteral/métodos , Feminino , Obstrução da Saída Gástrica/etiologia , Obstrução da Saída Gástrica/cirurgia , Gastroparesia/etiologia , Gastroparesia/cirurgia , Gastroscopia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Gastropatias/etiologia
14.
Eur J Pharm Biopharm ; 136: 192-202, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30659894

RESUMO

Characterization of dissolution of solid suspended drug particles in vivo is important for developing biopredictive in vitro tests. Therefore, methods to gain deeper insights into particle dissolution in vivo are needed. The soft Bioperm intubation method, a well established tool for investigation of permeability, absorption, metabolism, and drug interactions at predefined locations in the gastroinstinal tract, was modified. The novel intubation method involved pump-controlled infusion of pharmaceutical suspensions as well as simultaneous pH monitoring. This technique was used in a proof of concept study in healthy humans. Plasma sampling and non-compartmental analysis allowed comparison of three different ibuprofen drug products, a solution and two suspensions with different particle size distribution, as well as two different infusion rates. Both a particle size effect and an effect of altering infusion rates on pharmacokinetic parameters were shown. Moreover, it was possible to monitor intestinal pH changes after intestinal infusion. Infusion of ibuprofen resulted in a pH drop that was quantified by the concept of Area Between Curves (ABC).


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Duodeno/efeitos dos fármacos , Ibuprofeno/administração & dosagem , Bombas de Infusão , Absorção Intestinal/efeitos dos fármacos , Intubação Gastrointestinal/métodos , Adulto , Anti-Inflamatórios não Esteroides/química , Cápsulas , Composição de Medicamentos , Duodeno/metabolismo , Feminino , Humanos , Concentração de Íons de Hidrogênio , Ibuprofeno/química , Absorção Intestinal/fisiologia , Intubação Gastrointestinal/instrumentação , Masculino , Soluções Farmacêuticas/administração & dosagem , Soluções Farmacêuticas/química , Suspensões , Adulto Jovem
15.
Obes Surg ; 29(4): 1236-1241, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30613935

RESUMO

INTRODUCTION: The Ellipse intragastric balloon (EIGB) is a new swallowable balloon that does not require endoscopy at insertion or removal. The aim of this study is to investigate the safety of EIGB and its efficiency in weight reduction even after 1 year of expulsion. METHOD: Prospective study on our initial experience with a consecutive group of patients who underwent the insertion of EIGB in the period between September 2016 and February 2017. The patients were followed up to assess pain, nausea, and vomiting after procedure. As well as, the time of balloon extraction, route of extraction, and weight loss. RESULTS: Total of 112 patients underwent EIGB placement. A 1-year follow-up was obtained on 85% of patients. Mean weight and BMI before the procedure 92.2 kg and 34.3 kg/m2, respectively. One patient had small bowel obstruction. Six patients did not tolerate EIGB and three patients had early deflation. Total weight loss % (TWL%) 10.7, 10.9, and 7.9% at 3, 6, and at date of last follow-up. When data were stratified according to BMI into two groups: group 1 (BMI 27.5-34.9) and group 2 (BMI 35-49), the TWL% for group 1 at 3 months, 6 months, and last day of follow-up are as follows: 10.2%, 10.6%, and 8.8%, while it was 11.5%, 11.2%, and 6.6% for group 2. CONCLUSION: EIGB are effective, safe, and feasible non-invasive method for weight loss.


Assuntos
Remoção de Dispositivo , Balão Gástrico , Intubação Gastrointestinal , Obesidade Mórbida/terapia , Perda de Peso/fisiologia , Dor Abdominal/epidemiologia , Dor Abdominal/etiologia , Adulto , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/estatística & dados numéricos , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/instrumentação , Endoscopia Gastrointestinal/estatística & dados numéricos , Desenho de Equipamento , Feminino , Seguimentos , Balão Gástrico/efeitos adversos , Balão Gástrico/estatística & dados numéricos , Humanos , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/instrumentação , Intubação Gastrointestinal/métodos , Intubação Gastrointestinal/estatística & dados numéricos , Masculino , Náusea/epidemiologia , Náusea/etiologia , Obesidade Mórbida/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Vômito/epidemiologia , Vômito/etiologia , Adulto Jovem
19.
Anesth Analg ; 129(4): 1079-1086, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30234537

RESUMO

BACKGROUND: Hypertrophic pyloric stenosis in infants can cause a buildup of gastric contents. Orogastric tubes (OGTs) or nasogastric tubes (NGTs) are often placed in patients with pyloric stenosis before surgical management to prevent aspiration. However, exacerbation of gastric losses may lead to electrolyte abnormalities that can delay surgery, and placement has been associated with increased risk of postoperative emesis. Currently, there are no evidence-based guidelines regarding OGT/NGT placement in these patients. This study examines whether OGT/NGT placement before arrival in the operating room was associated with a longer time to readiness for surgery as defined by normalization of electrolytes. Secondary outcomes included time from surgery to discharge and ability to tolerate feeds by 6 hours postoperatively in patients with and without early OGT/NGT placement. METHODS: In this multicenter retrospective cohort study, data were extracted from the medical records of 481 patients who underwent pyloromyotomy for infantile hypertrophic pyloric stenosis from March 2013 to June 2016. Multivariable linear regression and Cox proportional hazard models were constructed to evaluate the association between placement of an OGT/NGT at the time of admission with increased time to readiness for surgery (defined as the time from admission to the first set of normalized laboratory values) and increased time from surgery to discharge. Multivariable logistic regression was used to evaluate the association between early OGT/NGT placement and the ability to tolerate oral intake at 6 hours postsurgery. Analyses were adjusted for site differences. RESULTS: Among patients admitted with electrolyte abnormalities, those with an OGT/NGT placed on presentation required more time until their serum electrolytes were at acceptable levels for surgery by regression analysis (19.2 hours difference; 95% confidence interval, 10.05-28.41; P < .001), after adjusting for site. Overall, patients who had OGTs/NGTs placed before presentation in the operating room had a longer length of stay from surgery to discharge than those without (38.8 hours difference; 95% confidence interval, 25.35-52.31; P < .001), after adjusting for site. OGT/NGT placement before surgery was not associated with failure to tolerate oral intake within 6 hours of surgery after adjusting for site, corrected gestational age, and baseline serum electrolytes. CONCLUSIONS: OGT/NGT placement on admission for pyloric stenosis is associated with a longer time to electrolyte correction in infants with abnormal laboratory values on presentation and, subsequently, a longer time until they are ready for surgery. It is also associated with longer postoperative hospital stay but not an increased risk of feeding intolerance within 6 hours of surgical repair.


Assuntos
Nutrição Enteral/instrumentação , Intubação Gastrointestinal/instrumentação , Estenose Pilórica/terapia , Tempo para o Tratamento , Fatores Etários , Nutrição Enteral/efeitos adversos , Feminino , Humanos , Lactente , Recém-Nascido , Intubação Gastrointestinal/efeitos adversos , Tempo de Internação , Masculino , Alta do Paciente , Complicações Pós-Operatórias/etiologia , Estenose Pilórica/diagnóstico , Estenose Pilórica/cirurgia , Estudos Retrospectivos , Fatores de Risco , Liberação de Cirurgia , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
20.
Eur Arch Otorhinolaryngol ; 276(1): 175-183, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30535974

RESUMO

PURPOSE: To establish a novel and effective reflux model with a modified nasogastric aspiration tube and to investigate the association between different types of nasogastric aspiration tubes and reflux laryngitis, we conducted this study. METHODS: Thirty-eight healthy New Zealand albino rabbits (2.5-3.5 kg) were divided into three groups: control (CTR, n = 6)-non-intubated; normal nasogastric intubation (NNI, n = 16)-intubated with 4#, 6#, 8#, and 10# normal nasogastric aspiration tubes; and modified nasogastric intubation (MNI, n = 16)-intubated with 4#, 6#, 8#, and 10# modified nasogastric aspiration tubes. The laryngoscopy, body weight, and pH values at the esophageal entrance were recorded before and 1, 2, and 4 weeks after intubation. After the final laryngoscopy, the animals in groups with a pH below 4 were sacrificed to obtain histological and gene expression analysis results. RESULTS: The reflux finding score (RFS) after 4 weeks showed that there was a statistically significant difference in the 8# NNI group (7 ± 0.816, P < 0.001), the 8# MNI group (11.5 ± 2.517, P < 0.001) and the 10# MNI (12.75 ± 1.893, P < 0.001) group compared with the control group (1.83 ± 1.602). The pH values of these three groups were lower than 4. However, the weight loss of the rabbits in the 10# NNI and 10# MNI groups was more obvious. Submucous gland hyperplasia and inflammation were significantly increased in the 8# NNI group, 8# MNI group and the 10# MNI group, but in the level of some pro-inflammatory cytokines and COX-2, the MNI group was significantly higher than the NNI group (8# NNI × 8# MNI, P < 0.01; 8# MNI × 10# MNI, P < 0.01). CONCLUSION: This study showed that 8# modified nasogastric intubation (MNI) produces effective reflux laryngitis in the rabbits.


Assuntos
Modelos Animais de Doenças , Laringite/etiologia , Refluxo Laringofaríngeo/complicações , Coelhos , Animais , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/instrumentação , Laringite/diagnóstico por imagem , Laringite/patologia , Refluxo Laringofaríngeo/diagnóstico por imagem , Refluxo Laringofaríngeo/patologia , Laringoscopia , Masculino , Distribuição Aleatória
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