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Cross HH. CE: Nursing Care for Patients After Ostomy Surgery. Am J Nurs 2023; 123:34-41. [PMID: 37498036 DOI: 10.1097/01.naj.0000947460.38199.fe] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
ABSTRACT When patients who undergo ostomy surgery do not have access to an ostomy care nurse, staff nurses must assume responsibility for providing ostomy care and educational support. However, many staff nurses may lack the necessary knowledge and skills to provide this type of care. This article details the basics of pre- and postoperative care and patient education for nurses who encounter patients with two of the most common types of ostomy surgery of the bowel: colostomy and ileostomy. It covers the care of a new stoma and provides information about emptying and changing the pouch, nutritional and lifestyle considerations, and possible complications.
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Affiliation(s)
- Heidi H Cross
- Heidi H. Cross is a wound and ostomy NP at Central New York Surgical Physicians in Syracuse and Strong Memorial Hospital in Rochester, NY. Contact author: . The author has disclosed no potential conflicts of interest, financial or otherwise
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Redij R, Kaur A, Muddaloor P, Sethi AK, Aedma K, Rajagopal A, Gopalakrishnan K, Yadav A, Damani DN, Chedid VG, Wang XJ, Aakre CA, Ryu AJ, Arunachalam SP. Practicing Digital Gastroenterology through Phonoenterography Leveraging Artificial Intelligence: Future Perspectives Using Microwave Systems. SENSORS (BASEL, SWITZERLAND) 2023; 23:2302. [PMID: 36850899 PMCID: PMC9967043 DOI: 10.3390/s23042302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
Production of bowel sounds, established in the 1900s, has limited application in existing patient-care regimes and diagnostic modalities. We review the physiology of bowel sound production, the developments in recording technologies and the clinical application in various scenarios, to understand the potential of a bowel sound recording and analysis device-the phonoenterogram in future gastroenterological practice. Bowel sound production depends on but is not entirely limited to the type of food consumed, amount of air ingested and the type of intestinal contractions. Recording technologies for extraction and analysis of these include the wavelet-based filtering, autoregressive moving average model, multivariate empirical mode decompression, radial basis function network, two-dimensional positional mapping, neural network model and acoustic biosensor technique. Prior studies evaluate the application of bowel sounds in conditions such as intestinal obstruction, acute appendicitis, large bowel disorders such as inflammatory bowel disease and bowel polyps, ascites, post-operative ileus, sepsis, irritable bowel syndrome, diabetes mellitus, neurodegenerative disorders such as Parkinson's disease and neonatal conditions such as hypertrophic pyloric stenosis. Recording and analysis of bowel sounds using artificial intelligence is crucial for creating an accessible, inexpensive and safe device with a broad range of clinical applications. Microwave-based digital phonoenterography has huge potential for impacting GI practice and patient care.
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Affiliation(s)
- Renisha Redij
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Avneet Kaur
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Pratyusha Muddaloor
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
| | - Arshia K. Sethi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
| | - Keirthana Aedma
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Keerthy Gopalakrishnan
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Ashima Yadav
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Devanshi N. Damani
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, TX 79995, USA
| | - Victor G. Chedid
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
| | - Xiao Jing Wang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | - Shivaram P. Arunachalam
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
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3
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Wang L, Huang L, Li S, Yang J, Tian W, Ji F, Wu K, Zheng M. Electroacupuncture Before Gastrectomy Accelerates Recovery from Gastrointestinal Dysfunction: A Feasibility Study. Med Acupunct 2022; 34:371-379. [PMID: 36644423 PMCID: PMC9805842 DOI: 10.1089/acu.2021.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective This study investigated the feasibility and effectiveness of preoperative electroacupuncture (EA), given within 30 minutes before surgery, on postoperative gastrointestinal dysfunction (PGD) in patients undergoing open gastrectomy. Materials and Methods Patients (N = 60) undergoing open gastrectomy were allocated randomly to a usual care (UC) group (n = 30) or an EA group (n = 30). Patients in the EA group were given bilateral EA on ST-36 (Zusanli), ST-37 (Shangjuxv), and ST-39 (Xiajuxv) within 30 minutes before the surgery. The UC group had no acupuncture treatment. Primary outcomes were feasibility of recruitment, retention, acceptability, and patients' global satisfaction. Secondary outcomes included time to first flatus, defecation, liquid diet, incidence and severity of abdominal distension (AD), and incidence of postoperative nausea (PON) and postoperative vomiting (POV). EA-related adverse events were recorded. Results Of the 61 recruited patients, 1 declined to participate and 60 were randomized into the 2 study groups. All participants completed the interventions. On the acceptability questionnaire, participants' acceptance of EA was statistically improved after the treatment (P < 0.001). Global satisfaction was higher in the EA group (P < 0.001) at 8 (range: 7-8) versus the UC group at 6 (range: 5-7), and the proportion of patients with at least good satisfaction (numerical scale of more than 7 of 10) reached 80% in the EA group. Compared to the UC group, the EA group had a shorter time to first flatus (EA: 57.67 ± 23.09 hours versus 71.27 ± 17.78 hours; P = 0.013). There were no significant differences in time to first defecation (P = 0.081) and liquid diet (P = 0.068), AD (P = 0.436), PON (P = 0.667), or POV (P = 1.000). EA-related adverse events were similar in the 2 groups (P = 1.000). Conclusions EA is feasible, acceptable to patients, and associated with higher postoperative satisfaction in patients undergoing open gastrectomy. A large multicentered trial is needed to test the effectiveness of EA on PGD.
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Affiliation(s)
- Liping Wang
- Department of Anesthesiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing City, Jiangsu Province, China
| | - Libing Huang
- Department of Anesthesiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing City, Jiangsu Province, China
| | - Sha Li
- Department of Anesthesiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing City, Jiangsu Province, China
| | - Jie Yang
- Department of Anesthesiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing City, Jiangsu Province, China
| | - Weiqian Tian
- Department of Anesthesiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing City, Jiangsu Province, China
| | - Fangbing Ji
- Department of Anesthesiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing City, Jiangsu Province, China
| | - Kangli Wu
- Department of Anesthesiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing City, Jiangsu Province, China
| | - Man Zheng
- Department of Anesthesiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing City, Jiangsu Province, China
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Huang H, Zhang Y, Shen L, Huang Y. Level of ERAS understanding affects practitioners' practice and perception of early postoperative resumption of oral intake: a nationwide survey. BMC Anesthesiol 2021; 21:279. [PMID: 34763674 PMCID: PMC8588702 DOI: 10.1186/s12871-021-01500-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/02/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Early postoperative resumption of oral intake is supposed to be safe and beneficial to patients recovery. However, practitioners still have great confusion and disagreement about postoperative resumption of oral intake. This is a nationwide survey to investigate the current status of clinical practice and practitioners' attitude toward postoperative resumption of oral intake along with their level of understanding of the ERAS guidelines. METHODS An anonymous web-based survey questionnaire via mobile social platform was carried out in mainland China from December 11-20, 2020. The Wilcoxon signed rank test or chi-square test was used to compare the propensity of the resumption of oral intake. RESULTS Totally 5370 responses were received, and 89% of them were from anesthesiology departments. The nature of the responses from clinical practitioners was highly diverse, but each of the three surgery types showed unique patterns of ERAS implementation. The respondents were more conservative regarding the commencement of both fluid and solid diets after gastrointestinal (GI) and hepato-pancreato-biliary (HPB) surgery than after non-abdominal (NA) surgery. Most respondents agreed that early oral intake is beneficial to reduce postoperative complications improve bowel recovery and overall outcome. 55% respondents considered themselves to have a better understanding of ERAS and tended to initiate oral intake early for all three surgery types (P < 0.001). CONCLUSIONS The postoperative resumption of oral intake is highly variable among GI, HPB and NA surgeries. A better understanding of ERAS would encourage practitioners to commence oral intake resumption much earlier.
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Affiliation(s)
- Huizhen Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Le Shen
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, 100730, China.
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, 100730, China
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Wells CI, Milne TGE, Seo SHB, Chapman SJ, Vather R, Bissett IP, O'Grady G. Post-operative ileus: definitions, mechanisms and controversies. ANZ J Surg 2021; 92:62-68. [PMID: 34676664 DOI: 10.1111/ans.17297] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 12/13/2022]
Abstract
Post-operative ileus (POI) is a syndrome of impaired gastrointestinal transit which occurs following abdominal surgery. There are few effective targeted therapies for ileus, and research has been limited by inconsistent definitions and an incomplete understanding of the underlying pathophysiology. Despite considerable effort, there remains no widely-adopted definition of ileus, and recent work has identified variation in outcome reporting is a major source of heterogeneity in clinical trials. Outcomes should be clearly-defined, clinically-relevant, and reflective of the underlying biology, impacts on hospital resources and quality of life. Further collaborative efforts will be needed to develop consensus definitions and a core outcome set for postoperative gastrointestinal recovery. Investigation into the pathophysiology of POI has been hindered by use of low-resolution techniques and difficulties linking cellular mechanisms to dysmotility patterns and clinical symptoms. Recent evidence has suggested the common assumption of post-operative GI paralysis is incorrect, and that the distal colon becomes hyperactive following surgery. The post-operative inflammatory response is important in the pathophysiology of ileus, but the time course of this in humans remains unclear, with the majority of evidence coming from animal models. Future work should investigate dysmotility patterns underlying ileus, and identify biomarkers which may be used to diagnose, monitor and stratify patients with ileus.
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Affiliation(s)
- Cameron I Wells
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Tony G E Milne
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Department of Surgery, Counties Manukau District Health Board, Auckland, New Zealand
| | - Sean Ho Beom Seo
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | | | - Ryash Vather
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ian P Bissett
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Department of Surgery, Auckland District Health Board, Auckland, New Zealand
| | - Greg O'Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Department of Surgery, Auckland District Health Board, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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Behera BK, Misra S, Jena SS, Mohanty CR. The effect of perioperative dexmedetomidine on postoperative bowel function recovery in adult patients receiving general anaesthesia: a systematic review and meta-analysis of randomised controlled trials. Minerva Anestesiol 2021; 88:51-61. [PMID: 34527407 DOI: 10.23736/s0375-9393.21.15773-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Dexmedetomidine has opioid sparing actions but its effect on bowel recovery is controversial. Primary aim of this review was to evaluate the effect of perioperative dexmedetomidine on postoperative bowel recovery. Secondary aim was to evaluate the effect of dexmedetomidine on hospital discharge. EVIDENCE ACQUISITION Randomised controlled trials in English language reporting any or all of the following parameters of bowel recovery; time to first bowel sounds, first flatus, first faeces, or time to oral diet were included. EVIDENCE SYNTHESIS Twelve hundred and thirty-five patients from 13 studies were analysed. There were insufficient studies evaluating bowel sounds. Perioperative dexmedetomidine usage significantly reduced the time to first flatus [MD -5.61 hours (95% CI -8.61 to -2.60); P = 0.0003; I2 = 95%], first faeces [MD -12.70 hours (95% CI -19.11 to -6.29); P = 0.0001; I2 = 76%] and the composite outcome of bowel recovery (flatus, faeces, oral diet) [MD -7.44 hours (95% CI -10.31 to -4.57); P < 0.00001; I2 = 96%]. No difference was seen in the time to oral diet [MD -6.29 hours (95% CI -13.48 to 0.91); P = 0.09; I2 = 88%] or hospital discharge [MD -0.47 days (95% CI -1.27 to 0.33); P = 0.25; I2 = 86%]. CONCLUSIONS Perioperative dexmedetomidine usage significantly shortens the time to first flatus, faeces and composite bowel recovery but does not result in a shorter time to oral diet or earlier hospital discharge in adult patients receiving general anaesthesia. Strength of evidence is however very low for the effect of dexmedetomidine on bowel recovery.
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Affiliation(s)
- Bikram K Behera
- Department of Anesthesiology & Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Satyajeet Misra
- Department of Anesthesiology & Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India -
| | - Sritam S Jena
- Department of Anesthesiology & Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Chitta R Mohanty
- Department of Trauma & Emergency Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
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Nowak JK, Nowak R, Radzikowski K, Grulkowski I, Walkowiak J. Automated Bowel Sound Analysis: An Overview. SENSORS (BASEL, SWITZERLAND) 2021; 21:5294. [PMID: 34450735 PMCID: PMC8400220 DOI: 10.3390/s21165294] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022]
Abstract
Despite technological progress, we lack a consensus on the method of conducting automated bowel sound (BS) analysis and, consequently, BS tools have not become available to doctors. We aimed to briefly review the literature on BS recording and analysis, with an emphasis on the broad range of analytical approaches. Scientific journals and conference materials were researched with a specific set of terms (Scopus, MEDLINE, IEEE) to find reports on BS. The research articles identified were analyzed in the context of main research directions at a number of centers globally. Automated BS analysis methods were already well developed by the early 2000s. Accuracy of 90% and higher had been achieved with various analytical approaches, including wavelet transformations, multi-layer perceptrons, independent component analysis and autoregressive-moving-average models. Clinical research on BS has exposed their important potential in the non-invasive diagnosis of irritable bowel syndrome, in surgery, and for the investigation of gastrointestinal motility. The most recent advances are linked to the application of artificial intelligence and the development of dedicated BS devices. BS research is technologically mature, but lacks uniform methodology, an international forum for discussion and an open platform for data exchange. A common ground is needed as a starting point. The next key development will be the release of freely available benchmark datasets with labels confirmed by human experts.
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Affiliation(s)
- Jan Krzysztof Nowak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, 60-572 Poznan, Poland;
| | - Robert Nowak
- Artificial Intelligence Division, Institute of Computer Science, Warsaw University of Technology, 00-665 Warsaw, Poland; (R.N.); (K.R.)
| | - Kacper Radzikowski
- Artificial Intelligence Division, Institute of Computer Science, Warsaw University of Technology, 00-665 Warsaw, Poland; (R.N.); (K.R.)
| | - Ireneusz Grulkowski
- Faculty of Physics, Astronomy and Informatics, Institute of Physics, Nicolaus Copernicus University, 87-100 Toruń, Poland;
| | - Jaroslaw Walkowiak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, 60-572 Poznan, Poland;
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Dudi-Venkata NN, Kroon HM, Bedrikovetski S, Lewis M, Lawrence MJ, Hunter RA, Moore JW, Thomas ML, Sammour T. Impact of STIMUlant and osmotic LAXatives (STIMULAX trial) on gastrointestinal recovery after colorectal surgery: randomized clinical trial. Br J Surg 2021; 108:797-803. [PMID: 34136900 DOI: 10.1093/bjs/znab140] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/06/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recovery of gastrointestinal (GI) function is often delayed after colorectal surgery. Enhanced recovery protocols (ERPs) recommend routine laxative use, but evidence of benefit is unclear. This study aimed to investigate whether the addition of multimodal laxatives to an ERP improves return of GI function in patients undergoing colorectal surgery. METHODS This was a single-centre, parallel, open-label RCT. All adult patients undergoing elective colorectal resection or having stoma formation or reversal at the Royal Adelaide Hospital between August 2018 and May 2020 were recruited into the study. The STIMULAX group received oral Coloxyl® with senna and macrogol, with a sodium phosphate enema in addition for right-sided operations. The control group received standard ERP postoperative care. The primary outcome was GI-2, a validated composite measure defined as the interval from surgery until first passage of stool and tolerance of solid intake for 24 h in the absence of vomiting. Secondary outcomes were the incidence of prolonged postoperative ileus (POI), duration of hospital stay, and postoperative complications. The analysis was performed on an intention-to-treat basis. RESULTS Of a total of 170 participants, 85 were randomized to each group. Median GI-2 was 1 day shorter in the STIMULAX compared with the control group (median 2 (i.q.r. 1.5-4) versus 3 (2-5.5) days; 95 per cent c.i. -1 to 0 days; P = 0.029). The incidence of prolonged POI was lower in the STIMULAX group (22 versus 38 per cent; relative risk reduction 42 per cent; P = 0.030). There was no difference in duration of hospital day or 30-day postoperative complications (including anastomotic leak) between the STIMULAX and control groups. CONCLUSION Routine postoperative use of multimodal laxatives after elective colorectal surgery results in earlier recovery of gastrointestinal function and reduces the incidence of prolonged POI. Registration number: ACTRN12618001261202 (www.anzctr.org.au).
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Affiliation(s)
- N N Dudi-Venkata
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - H M Kroon
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - S Bedrikovetski
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - M Lewis
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - M J Lawrence
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - R A Hunter
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - J W Moore
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - M L Thomas
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - T Sammour
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Bowker B, Calabrese RO, Barber E. Postoperative Ileus. PHYSICIAN ASSISTANT CLINICS 2021. [DOI: 10.1016/j.cpha.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Deane AM, Ali Abdelhamid Y, Plummer MP, Fetterplace K, Moore C, Reintam Blaser A. Are Classic Bedside Exam Findings Required to Initiate Enteral Nutrition in Critically Ill Patients: Emphasis on Bowel Sounds and Abdominal Distension. Nutr Clin Pract 2020; 36:67-75. [PMID: 33296117 DOI: 10.1002/ncp.10610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023] Open
Abstract
The general physical examination of a patient is an axiom of critical care medicine, but evidence to support this practice remains sparse. Given the lack of evidence for a comprehensive physical examination of the entire patient on admission to the intensive care unit, which most clinicians consider an essential part of care, should clinicians continue the practice of a specialized gastrointestinal system physical examination when commencing enteral nutrition in critically ill patients? In this review of literature related to gastrointestinal system examination in critically ill patients, the focus is on gastrointestinal sounds and abdominal distension. There is a summary of what these physical features represent, an evaluation of the evidence regarding use of these physical features in patients after abdominal surgery, exploration of the rationale for and against using the physical findings in routine practice, and detail regarding what is known about each feature in critically ill patients. Based on the available evidence, it is recommended that an isolated symptom, sign, or bedside test does not provide meaningful information. However, it is submitted that a comprehensive physical assessment of the gastrointestinal system still has a role when initiating or administering enteral nutrition: specifically, when multiple features are present, clinicians should consider further investigation or intervention.
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Affiliation(s)
- Adam M Deane
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, The University of Melbourne, Parkville, Victoria, Australia
| | - Yasmine Ali Abdelhamid
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, The University of Melbourne, Parkville, Victoria, Australia
| | - Mark P Plummer
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, The University of Melbourne, Parkville, Victoria, Australia
| | - Kate Fetterplace
- Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, The University of Melbourne, Parkville, Victoria, Australia.,Allied Health (Clinical Nutrition), Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Cara Moore
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.,Department of Intensive Care, Lucerne Cantonal Hospital, Lucerne, Switzerland
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11
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Yang J, Huang L, Liu S, Wu W, Tian W, Zheng Z, Lv Z, Ji F, Zheng M. Effect of Electroacupuncture on Postoperative Gastrointestinal Recovery in Patients Undergoing Thoracoscopic Surgery: A Feasibility Study. Med Sci Monit 2020; 26:e920648. [PMID: 32445558 PMCID: PMC7260999 DOI: 10.12659/msm.920648] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The aim of this study was to study the feasibility and acceptability of electroacupuncture (EA) for preventing postoperative gastrointestinal complications in patients undergoing thoracoscopic segmentectomy/lobectomy. Material/Methods Sixty patients who underwent video-assisted thoracoscopic (VATS) segmentectomy/lobectomy received either EA treatments plus usual care (EA group) or usual care alone (UC group). Patients in the EA group were given 30 minutes of bilateral electroacupuncture on 3 acupoints [Neiguan (PC6), Zusanli (ST36), and Shangjuxu (ST37)] at 3 time points (24 hours before surgery, and 4 hours and 24 hours after surgery). The primary outcomes were recruitment, retention, acceptability of the EA intervention, incidence and severity of abdominal distension (AD), and time to first flatus and defecation. Secondary outcomes included postoperative nausea and vomiting (PONV), pain intensity, and duration of hospital stay. Results We recruited 60 participants and 59 were randomized into 2 groups for this study: 30 in the EA group and 29 in the UC group. In total, 57 participants completed the study. With the exception of one participant in the EA group, all participants completed all three sessions of EA. The one exclusion was a case where a paravertebral block was not used during the surgery. Qualitative findings from the acceptability questionnaire indicated that participants viewed the EA treatment as acceptable. After EA treatment, there was a small but statistically significant improvement in participants’ acceptance of EA for alleviating postoperative gastrointestinal discomfort (P=0.001). The EA group showed improved outcomes compared to the UC group in terms of time to first flatus (20.8±4.6 versus 24.1±6.2 hours, P=0.026) and defecation (53.9±6.0 versus 57.5±7.2 hours, P=0.046). No significant differences appeared regarding AD, rescue medication, or duration of hospitalization. PONV and pain intensity were similar in both groups at the recorded time periods. Conclusions EA is feasible and acceptable to patients undergoing VATS surgery. Our preliminary findings of EA promoting postoperative recovery of gastrointestinal function warrants large randomized controlled trials.
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Affiliation(s)
- Jie Yang
- Department of Anesthesiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
| | - Libing Huang
- Department of Anesthesiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
| | - Siying Liu
- Department of Anesthesiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
| | - Wenzhong Wu
- Department of Acupuncture and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
| | - Weiqian Tian
- Department of Anesthesiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
| | - Zhen Zheng
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology (RMIT) University, Melbourne, Australia
| | - Zhigang Lv
- Department of Pharmacology, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
| | - Fangbing Ji
- Department of Anesthesiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
| | - Man Zheng
- Department of Anesthesiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
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Colon Myoelectric Activity Measured After Open Abdominal Surgery with a Noninvasive Wireless Patch System Predicts Time to First Flatus. J Gastrointest Surg 2019; 23:982-989. [PMID: 30390183 DOI: 10.1007/s11605-018-4030-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/22/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Passage of flatus after abdominal surgery signals resolution of physiological postoperative ileus (POI) and often, particularly after complex open surgeries, serves as the trigger to initiate oral feeding. To date, there is no objective tool that can predict time to flatus allowing for timely feeding and optimizing recovery. In an open, prospective study, we examine the use of a noninvasive wireless patch system that measures electrical activity from gastrointestinal smooth muscles in predicting time to first flatus. METHODS Eighteen patients who underwent open abdominal surgery at El Camino Hospital, Mountain View, CA, were consented and studied. Immediately following surgery, wireless patches were placed on the patients' anterior abdomen. Colonic frequency peaks in the spectra were identified in select time intervals and the area under the curve of each peak times its duration was summed to calculate cumulative myoelectrical activity. RESULTS Patients with early flatus had stronger early colonic activity than patients with late flatus. At 36 h post-surgery, a linear fit of time to flatus vs cumulative colonic myoelectrical activity predicted first flatus as much as 5 days (± 22 h) before occurrence. CONCLUSIONS In this open, prospective pilot study, noninvasive measurement of colon activity after open abdominal surgery was feasible and predictive of time to first flatus. Interventions such as feeding can potentially be optimized based on this prediction, potentially improving outcomes, decreasing length of stay, and lowering costs.
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Padar M, Starkopf J, Uusvel G, Reintam Blaser A. Gastrointestinal failure affects outcome of intensive care. J Crit Care 2019; 52:103-108. [PMID: 31035184 DOI: 10.1016/j.jcrc.2019.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/19/2019] [Accepted: 04/01/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Goal of this study was to describe incidence and outcome of gastrointestinal failure (GIF) in ICU patients, evaluate its additive role to SOFA score in mortality prediction and describe GIF according to etiology. MATERIALS AND METHODS A retrospective study with prospective data collection was conducted in mixed adult ICU patients admitted 2004-2015. GIF was considered present if ≥3 of following 6 symptoms occurred in 1 day: maximum gastric residual volume ≥ 500 mL; absent bowel sounds; vomiting or regurgitation; diarrhea; suspected or radiologically confirmed bowel distension; gastrointestinal bleeding. Division into primary (gastrointestinal pathology causing GIF) and secondary (due to other conditions) GIF was made based on origin of syndrome. RESULTS GIF developed in 413 (10.4%) of 3959 patients. Primary GIF occurred in 61.3% and secondary GIF in 38.7% of patients. Development of GIF was associated with longer mechanical ventilation, ICU stay and higher ICU, 30-day and 90-day mortality. Outcomes of patients with primary and secondary GIF were similar. All SOFA sub-scores and number of gastrointestinal symptoms on admission day independently predicted 90-day mortality. CONCLUSIONS Gastrointestinal failure, independent of origin, is associated with worse ICU outcome. Similar to other organ failures included in SOFA score, GIF independently predicts mortality.
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Affiliation(s)
- Martin Padar
- Department of Anaesthesiology and Intensive Care, University of Tartu, 50406 Tartu, Estonia; Department of Anaesthesiology and Intensive Care, Tartu University Hospital, L. Puusepa 8, 50406 Tartu, Estonia.
| | - Joel Starkopf
- Department of Anaesthesiology and Intensive Care, University of Tartu, 50406 Tartu, Estonia; Department of Anaesthesiology and Intensive Care, Tartu University Hospital, L. Puusepa 8, 50406 Tartu, Estonia.
| | - Gerli Uusvel
- Department of Anaesthesiology and Intensive Care, Tartu University Hospital, L. Puusepa 8, 50406 Tartu, Estonia.
| | - Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, 50406 Tartu, Estonia; Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Lucerne Cantonal Hospital, Spitalstrasse, 6000 Lucerne, Switzerland.
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14
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Chapman SJ, Thorpe G, Vallance AE, Harji DP, Lee MJ, Fearnhead NS. Systematic review of definitions and outcome measures for return of bowel function after gastrointestinal surgery. BJS Open 2018; 3:1-10. [PMID: 30734010 PMCID: PMC6354191 DOI: 10.1002/bjs5.102] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/06/2018] [Indexed: 12/11/2022] Open
Abstract
Background Ileus is common after gastrointestinal surgery and has been identified as a research priority. Several issues have limited previous research, including a widely accepted definition and agreed outcome measure. This review is the first stage in the development of a core outcome set for the return of bowel function after gastrointestinal surgery. It aims to characterize the extent of variation in current outcome reporting. Methods A systematic search of MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and the Cochrane Library was performed for 1990–2017. RCTs of adults undergoing gastrointestinal surgery, including at least one reported measure relating to return of bowel function, were eligible. Trial registries were searched across the same period for ongoing and completed (but not published) RCTs. Definitions of ileus and outcome measures describing the return of bowel function were extracted. Results Of 5670 manuscripts screened, 215 (reporting 217 RCTs) were eligible. Most RCTs involved patients undergoing colorectal surgery (161 of 217, 74·2 per cent). A total of 784 outcomes were identified across all published RCTs, comprising 73 measures (clinical: 63, 86 per cent; radiological: 6, 8 per cent; physiological: 4, 5 per cent). The most commonly reported outcome measure was ‘time to first passage of flatus’ (140 of 217, 64·5 per cent). The outcomes ‘ileus’ and ‘prolonged ileus’ were defined infrequently and variably. Conclusion Outcome reporting for the return of bowel function after gastrointestinal surgery is variable and not fit for purpose. An agreed core outcome set will improve the consistency, reliability and clinical value of future studies.
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Affiliation(s)
- S J Chapman
- Leeds Institute of Biomedical and Clinical Sciences University of Leeds Leeds UK
| | - G Thorpe
- Faculty of Medicine and Health Sciences University of East Anglia Norwich UK
| | | | - D P Harji
- Newcastle Centre for Bowel Disease, Royal Victoria Infirmary Newcastle upon Tyne UK
| | - M J Lee
- Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK
| | - N S Fearnhead
- Department of Colorectal Surgery Cambridge University Hospitals NHS Foundation Trust Cambridge UK
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Abstract
Secondary peritonitis accounts for 1% of urgent or emergent hospital admissions and is the second leading cause of sepsis in patients in intensive care units globally. Overall mortality is 6%, but mortality rises to 35% in patients who develop severe sepsis. Despite the dramatic growth in the availability and use of imaging and laboratory tests, the rapid diagnosis and early management of peritonitis remains a challenge for physicians in emergency medicine, surgery, and critical care. In this article, we review the pathophysiology of peritonitis and its potential progression to sepsis, discuss the utility and limitations of the physical examination and laboratory and radiographic tests, and present a paradigm for the management of secondary peritonitis.
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Affiliation(s)
- James T Ross
- Department of Surgery, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Michael A Matthay
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Hobart W Harris
- Department of Surgery, University of California, San Francisco, San Francisco, CA 94143, USA
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