Metabolic and Nutritional Support of the Intensive Care Patient: Ascending the Learning Curve

Management of sepsis in neutropenia: guidelines of the infectious diseases working party (AGIHO) of the German Society of Hematology and Oncology (DGHO)

These guidelines from the infectious diseases working party (AGIHO) of the German Society of Hematology and Oncology (DGHO) give recommendations for the management of adults with neutropenia and the diagnosis of sepsis. The guidelines are written for clinicians and focus on pathophysiology, diagnosis, and treatment of sepsis. The manuscript contains evidence-based recommendations for the assessment of the quality and strength of the data.

The contemporary surgical intensive care unit. Structure, staffing, and issues

Modern ICUs present unique challenges to physician-administrators in the current health care environment. Several models of care (e.g., open versus closed ICUs, physician extenders in the ICU) are used throughout the country, with varying degrees of success. Although all care models may work, the ideal model for a given ICU can be found only through ongoing performance improvement.

Modifying perfusion, nutrition, and stress to promote wound healing in patients with acute wounds

Tissue injury is common among patients in acute care settings. The subsequent response to injury, wound healing, follows an intricate but well-defined sequence that, under normal conditions, proceeds to satisfactory repair. However, because of the complexity of the healing response, several factors can intervene to impair normal healing. As a better understanding of how diverse factors influence healing is gained, the use of interventions that modulate these factors becomes possible and potentially beneficial. This article reviews knowledge of perfusion, nutrition, and stress as they relate to healing in patients experiencing acute wounds. Therapeutic implications based on current research are discussed.

Air insufflation technique of enteral tube insertion: a randomized, controlled trial

OBJECTIVE

To test air insufflation as an adjunct to placement of enteral feeding tubes.

DESIGN

Prospective, randomized study.

SETTING

Intensive care unit in a tertiary hospital.

SUBJECTS

Sixty-four consecutive patients requiring enteral nutrition, in whom a decision to insert a nasoenteral feeding tube was made.

INTERVENTIONS

A 12-Fr feeding tube was inserted to the level of the fundus of the stomach. A 60-mL syringe was used to pump 500 mL of air into the stomach. The tube was then advanced. An abdominal flat plate was obtained within 2 hrs of completion of the procedure and the tube position noted. If the tube was not in the duodenum, the patient was placed on a promotility agent and a repeat radiograph was performed the next day. The technique varied from our control technique only by the instillation of air.

MEASUREMENTS AND MAIN RESULTS

Using the study technique, 21 of 32 tubes were successfully placed, as seen on the initial radiograph, in our study patients compared with only 12 of 34 tubes in our control patients (p< .02). In addition, the success rate at 24 hrs was 25 of 32 vs. 16 of 34 (p< .02). Only 3 of 21 tubes placed in the antrum, body, or fundus of the stomach advanced to the duodenum the following day, compared with 5 of 12 tubes initially placed in the pylorus (p< .075). No complications were noted.

CONCLUSION

Instilling air into the stomach may facilitate the ability to get the feeding tube to the level of the pylorus, at which point it is more likely to advance into the duodenum and beyond.