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Ben-Arie E, Lottering BJ, Chen FP, Ho WC, Lee YC, Inprasit C, Kao PY. Is acupuncture safe in the ICU? A systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1190635. [PMID: 37692789 PMCID: PMC10484589 DOI: 10.3389/fmed.2023.1190635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/28/2023] [Indexed: 09/12/2023] Open
Abstract
Background and purpose The safety of interventions for critically ill patients is a crucial issue. In recent years, several studies have treated critically ill patients with acupuncture. However, the safety of acupuncture in this setting remains to be systematically measured. Methods In May 2022, the electronic databases of PubMed and the Cochrane Library were searched for studies comparing acupuncture interventions to control interventions in critically ill patients. Study outcomes examined the incidence of severe adverse events (AEs), minor AEs, adverse reactions, ICU stays, and 28-day mortality. Results A total of 31 articles were analyzed, and no serious AEs related to acupuncture treatment were identified. No significant differences were found between the groups in the meta-analysis of minor AEs (risk ratio [RR] 5.69 [0.34, 96.60], P = 0.23, I2 = 76%). A reduced risk in the incidence of adverse reactions following acupuncture intervention was evidenced (RR 0.33 [0.22, 0.50], P = 0.00001, I2 = 44%). The patients in the acupuncture arm spent significantly less time in the intensive care unit (ICU) (Mean difference -1.45 [-11.94, -10.97], P = 0.00001, I2 = 56%) and also exhibited lower 28-day mortality rates (odds ratio 0.61 [0.48, 0.78], P = 0.0001, I2 = 0%). Conclusion There is no evidence to indicate a higher risk of severe or minor AEs in patients who receive acupuncture. Acupuncture demonstrated favorable results in both ICU stay and 28-day mortality measurements, in addition to presenting with fewer adverse reactions compared to routine ICU care. However, the low certainty of the evidence resulting from a high risk of bias in the included studies merits substantial consideration, and further research is still warranted. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=142131, identifier: CRD42020142131.
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Affiliation(s)
- Eyal Ben-Arie
- Graduate School of Acupuncture Science, China Medical University, Taichung, Taiwan
| | | | - Fang-Pey Chen
- Institute of Traditional Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Chao Ho
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Yu-Chen Lee
- Graduate School of Acupuncture Science, China Medical University, Taichung, Taiwan
- Department of Acupuncture, China Medical University Hospital, Taichung, Taiwan
- Chinese Medicine Research Center, China Medical University, Taichung, Taiwan
| | - Chanya Inprasit
- Suphanburi Campus Establishment Project, Kasetsart University, Suphan Buri, Thailand
| | - Pei-Yu Kao
- Institute of Traditional Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Surgical Intensive Care Unit, China Medical University Hospital, Taichung, Taiwan
- Division of Thoracic Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan
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Crone V, Møller MH, Baekgaard ES, Perner A, Bytzer P, Alhazzani W, Krag M. Use of prokinetic agents in hospitalised adult patients: A scoping review. Acta Anaesthesiol Scand 2023; 67:588-598. [PMID: 36847067 DOI: 10.1111/aas.14222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/09/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Gastrointestinal motility is important for adequate uptake of fluids and nutrition but is often impaired in hospitalised patients. Prokinetic agents enhance gastrointestinal motility and are prescribed for many hospitalised patients. In this scoping review, we aimed to systematically describe the body of evidence on the use of prokinetic agents in hospitalised patients. We hypothesised, that the body of evidence would be limited and derive from heterogeneous populations. METHODS We conducted this scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews statement. We searched Medline, Embase, Epistemonikos and the Cochrane Library for studies assessing the use of prokinetic agents on any indication and outcome in adult hospitalised patients. We used a modified version of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the certainty of evidence. RESULTS We included 102 studies with a total of 8830 patients. Eighty-six studies were clinical trials (84%), and 52 (60%) of these were conducted in the intensive care unit, with feeding intolerance as the main indication. In the non-intensive care setting the indications were wider; most studies assessed use of prokinetic agents before gastroscopy to improve visualisation. The most studied prokinetic agent was metoclopramide (49% of studies) followed by erythromycin (31%). In total 147 outcomes were assessed with only 67% of the included studies assessing patient-centred outcomes, and with gastric emptying as the most frequently reported outcome. Overall, the data provided no firm evidence on the balance between the desirable and undesirable effects of prokinetic agents. CONCLUSIONS In this scoping review, we found that the studies addressing prokinetic agents in hospitalised adults had considerable variations in indications, drugs and outcomes assessed, and that the certainty of evidence was judged to be low to very low.
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Affiliation(s)
- Vera Crone
- Department of Intensive Care, Holbaek Hospital, Holbaek, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Anders Perner
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Bytzer
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Gastroenterology, Zealand University Hospital, Køge, Denmark
| | - Waleed Alhazzani
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Critical Care Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mette Krag
- Department of Intensive Care, Holbaek Hospital, Holbaek, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Formenti P, Piuri G, Bisatti R, Pinciroli R, Umbrello M. Role of acupuncture in critically ill patients: A systematic review. J Tradit Complement Med 2022; 13:62-71. [PMID: 36685071 PMCID: PMC9845654 DOI: 10.1016/j.jtcme.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/07/2022] Open
Abstract
Acupuncture is part of a complex medical approach used in China for about 2000 years, known as Traditional Chinese Medicine, whose central assumption is that health occurs when the patterned energy flow throughout the body is balanced. Within this paradigm, acute illness occurs when a major state of imbalance or disruption arises, and the use of acupuncture may help in correcting these imbalances. While the Chinese hospital system often offers the integration of traditional and western medicine, in Europe and the United States this combined approach is infrequently practiced. However, several investigations have consistently shown the effectiveness of acupuncture for different aspects of critical illness. The aim of this systematic review is to increase the clinician's awareness of the current evidence regarding the use of acupuncture for the management of critically ill patients, both alone or as a complement to western medicine. The effects of acupuncture on critical illness, with a particular focus on respiratory function, pain and delirium treatment and prevention, circulatory function, nutritional support, and recovery after acute illness are explored and summarized, and evidence is provided that acupuncture is an acceptable and feasible option for the management of several aspects of critical illness. In addition, we suggest a practical selection of potentially useful acupuncture points in the critical care setting, with indications for simple localization and the correct puncture method.
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Affiliation(s)
- Paolo Formenti
- SC Anestesia e Rianimazione, Ospedale San Paolo – Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy
| | | | | | - Riccardo Pinciroli
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Michele Umbrello
- SC Anestesia e Rianimazione II, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo – Polo Universitario, Milan, Italy,Corresponding author. SC Anestesia e Rianimazione II, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo – Polo Universitario, 20151, Milano, Italy.
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Abstract
Gastroparesis is characterized by symptoms suggesting retention of food in the stomach with objective evidence of delayed gastric emptying in the absence of mechanical obstruction in the gastric outflow. This condition is increasingly encountered in clinical practice. These guidelines summarize perspectives on the risk factors, diagnosis, and management of gastroparesis in adults (including dietary, pharmacological, device, and interventions directed at the pylorus), and they represent the official practice recommendations of the American College of Gastroenterology. The scientific evidence for these guidelines was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation process. When the evidence was not appropriate for Grading of Recommendations, Assessment, Development, and Evaluation, we used expert consensus to develop key concept statements. These guidelines should be considered as preferred but are not the only approaches to these conditions.
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Chen KB, Wu ZW, Wang J, Zhu LH, Jin XL, Chen GF, Kang MX, Huang Y, Zhang H, Lin LL, Shi DK, Wu D, Chen JF, Chen J, Zhao ZQ. Efficacy and safety of long-term transcutaneous electroacupuncture versus sham transcutaneous electroacupuncture for delayed gastric emptying after distal gastrectomy: study protocol for a randomized, patient-assessor blinded, controlled trial. Trials 2022; 23:189. [PMID: 35241130 PMCID: PMC8895584 DOI: 10.1186/s13063-022-06108-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 02/15/2022] [Indexed: 02/04/2023] Open
Abstract
Background Delayed gastric emptying (DGE) after distal gastrectomy impacts patients’ nutritional status and quality of life. The current treatments of DGE seem unsatisfactory or need invasive interventions. It is unknown whether transcutaneous electroacupuncture (TEA) is effective in treating DGE. Methods A total of 90 eligible participants who underwent distal gastrectomy will be randomly allocated to either the TEA group (n = 60) or the sham transcutaneous electroacupuncture (sham-TEA) group (n = 30). Each participant will receive TEA on the bilateral acupoints of Zusanli (ST36) and Neiguan (PC6) for 4 weeks. The primary outcomes will be the residual rates of radioactivity in the stomach by gastric scintigraphy and total response rates. The secondary outcomes will be endoscopic features, autonomic function, nutritional and psychological status, serum examination, and quality of life (QoL). The adverse events will also be reported. The patients will be followed up 1 year after the treatment. Discussion The findings of this randomized trial will provide high-quality evidence regarding the efficacy and safety of long-term TEA for treating DGE after distal gastrectomy. Trial registration Chinese Clinical Trial Registry ChiCTR2000033965. Registered on 20 June 2020
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Affiliation(s)
- Kai-Bo Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Zhi-Wei Wu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Jun Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Ling-Hua Zhu
- Department of Gastrointestinal Surgery, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, No. 3 East Qing-Chun Road, Hangzhou, 310020, China
| | - Xiao-Li Jin
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Guo-Feng Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Mu-Xing Kang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Yi Huang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Hang Zhang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Le-Le Lin
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Di-Ke Shi
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Dan Wu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Jian-Feng Chen
- Department of General Surgery, Shang-Yu branch of SAHZU, School of Medicine, No. 517 Shi-Min Road, Shaoxing, 312300, China
| | - Jian Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University (SAHZU), School of Medicine, No.88 Jie-Fang Road, Hangzhou, 310009, China
| | - Zhi-Qing Zhao
- Department of General Surgery, Shang-Yu branch of SAHZU, School of Medicine, No. 517 Shi-Min Road, Shaoxing, 312300, China.
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Digestion-Specific Acupuncture Effect on Feeding Intolerance in Critically Ill Post-Operative Oral and Hypopharyngeal Cancer Patients: A Single-Blind Randomized Control Trial. Nutrients 2021; 13:nu13062110. [PMID: 34205461 PMCID: PMC8234819 DOI: 10.3390/nu13062110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 12/13/2022] Open
Abstract
Malnourishment is prevalent in patients suffering from head and neck cancer. The postoperative period is crucial in terms of nutritional support, especially after composite resection and reconstruction surgery. These patients present with a number of risk factors that aggravate feeding intolerance, including postoperative status, prolonged immobility, decreased head elevation, mechanical ventilation, and applied sedative agents. Routine management protocols for feeding intolerance include prokinetic drug use and post-pyloric tube insertion, which could be both limited and accompanied by detrimental adverse events. This single-blind clinical trial aimed to investigate the effects of acupuncture in postoperative feeding intolerance in critically ill oral and hypopharyngeal cancer patients. Twenty-eight patients were randomized into two groups: Intervention group and Control group. Interventions were administered daily over three consecutive postoperative days. The primary outcome revealed that the intervention group reached 70% and 80% of target energy expenditure (EE) significantly earlier than the control group (4.00 ± 1.22 versus 6.69 ± 3.50 days, p = 0.012), accompanied by higher total calorie intake within the first postoperative week (10263.62 ± 1086.11 kcals versus 8384.69 ± 2120.05 kcals, p = 0.004). Furthermore, the intervention group also needed less of the prokinetic drug (Metoclopramide, 20.77 ± 48.73 mg versus 68.46 ± 66.56 mg, p = 0.010). In conclusion, digestion-specific acupuncture facilitated reduced postoperative feeding intolerance in oral and hypopharyngeal cancer patients.
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Holmer N, Artola E, Christianson E, Lynn AM, Whitlock KB, Norton S. Feasibility of Acupuncture to Induce Sleep for Brainstem Auditory Evoked Response Testing. Am J Audiol 2019; 28:895-907. [PMID: 31747523 DOI: 10.1044/2019_aja-19-0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose Brainstem auditory evoked response (BAER) testing is often performed under general anesthesia for children unable to complete behavioral audiologic evaluation. Alternatively, acupuncture treatment may be considered appropriate for BAER. Reports of acupuncture treatment in pediatric patients are scarce but are needed to demonstrate effectiveness. This study had 2 main objectives: (a) to examine the feasibility and effectiveness of acupuncture to achieve sleep to perform diagnostic BAER testing in medically complex (Cohort I) and nonmedically complex (Cohort II) children and (b) to assess acceptability to parents and audiologists of acupuncture as an alternative to anesthesia for BAER testing. Method A prospective feasibility study at Seattle Children's Hospital Outpatient Audiology Clinic from August 2015 through December 2018 was performed. A total of 31 pediatric patients were included. The median age for Cohort I was 29 months (interquartile range: 19-37 months), and the median age for Cohort II was 25.5 months (interquartile range: 16-32 months). Variables included number of BAER thresholds obtained, sleep indicators, and acceptability. The cost of BAER with acupuncture and the cost of BAER under anesthesia were compared. Results Acupuncture treatment effectively contributed to an adequate sleep state to obtain BAER results for most patients in both cohorts. Across cohorts, most patients (81%) fell asleep after acupuncture treatment. Complete test results were obtained in 48% of patients. Audiologists and parents reported high satisfaction rates with this procedure (87%). There were no adverse safety effects. Acupuncture treatment was less costly than anesthesia for BAER testing. Conclusions Acupuncture to induce sleep for BAER testing is effective, safe, and cost-efficient in small samples of medically and nonmedically complex pediatric patients. This procedure allowed earlier detection of hearing status and avoided potential adverse effects of anesthesia. Audiologists and parents reported that acupuncture treatment was an acceptable alternative to anesthesia for the BAER procedure.
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Affiliation(s)
- Nicole Holmer
- Division of Audiology, Seattle Children's Hospital, WA
| | - Elizabeth Artola
- Department of Anesthesia and Pain Medicine, Seattle Children's Hospital, WA
| | | | - Anne M. Lynn
- Department of Anesthesia and Pain Medicine, Seattle Children's Hospital, WA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
| | - Kathryn B. Whitlock
- Department of Otolaryngology–Head and Neck Surgery, Seattle Children's Hospital, WA
- Center for Clinical and Translational Research, Seattle Children's Hospital, WA
| | - Susan Norton
- Division of Audiology, Seattle Children's Hospital, WA
- Childhood Communication Center, Seattle Children's Hospital, WA
- Department of Otolaryngology–Head and Neck Surgery, Seattle Children's Hospital, WA
- Department of Speech & Hearing Sciences, University of Washington, Seattle
- Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle
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Ben-Arie E, Kao PY, Ho WC, Lee YC. Acupuncture effect on digestion in critically ill postoperative oral and hypopharyngeal cancer patients: A protocol for double-blind randomized control trial. Medicine (Baltimore) 2019; 98:e16944. [PMID: 31464933 PMCID: PMC6736481 DOI: 10.1097/md.0000000000016944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Head and neck cancer patients are at a high risk to suffer from malnourishment, a risk that increases in postoperative condition and with the use of enteral nutrition (EN). Until now patients who are suffering from indigestion in the intensive care unit (ICU) received treatment in the form of prokinetic drugs, drugs that can lead to serious side effects and only can partially improve digestion functions. Acupuncture was used successfully in several clinical trials to improve postoperative indigestion in cancer patients without any reported adverse events. The study aims are to investigate acupuncture effect in combination with prokinetic drugs in the treatment of indigestion in postoperative oral and hypopharyngeal cancer patients in the ICU. METHODS Single-center, double-blind randomized control trial will compare between 2 equal groups. A total of 28 patients that will meet the inclusion criteria: age 30 to 80, postplastic surgery for oral cancer or hypopharyngeal cancer, developed feeding intolerance 2 times in the first postoperative day, Apache score <20, and needed EN. Patients will be randomly divided (1:1) into treatment group or control group for 3 treatments in 3 days along with routine ICU treatment. The main outcome measurement will be the number of days a patient needs to reach his total energy expenditure. EXPECTED OUTCOME The results will shed light on the effectiveness and safety of acupuncture in a double-blind design treating postoperative ICU cancer patients. In addition, the study presents a revolutionary double-blind design that if, will prove as successful might influence the way double-blind acupuncture studies are performed today. OTHER INFORMATION The study will be conducted in the surgical ICU department, of China medical university hospital, Taichung 404, Taiwan. The study is conducted on stable ICU patients and is anticipated to have minimum risk for adverse events. Patients enrollment and data collection will start from May 15, 2019. The study expected completion time: June 2021.
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Affiliation(s)
- Eyal Ben-Arie
- Graduate Institute of Acupuncture Science (Collage of Chinese Medicine) China Medical University
| | - Pei-Yu Kao
- Division of Thoracic Surgery, Department of Surgery
- Surgical Intensive Care Unit
| | - Wen-Chao Ho
- Department of Public Health, China Medical University
- Department of Nursing and Graduate Institute of Nursing, Asia University, Taichung, Taiwan
| | - Yu Chen Lee
- Graduate Institute of Acupuncture Science (Collage of Chinese Medicine) China Medical University
- Department of Acupuncture, China Medical University Hospital
- Chinese Medicine Research Center, China Medical University
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Nguyen TAN, Ali Abdelhamid Y, Weinel LM, Hatzinikolas S, Kar P, Summers MJ, Phillips LK, Horowitz M, Jones KL, Deane AM. Postprandial hypotension in older survivors of critical illness. J Crit Care 2018; 45:20-26. [PMID: 29413718 DOI: 10.1016/j.jcrc.2018.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 12/07/2017] [Accepted: 01/10/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE In older people postprandial hypotension occurs frequently; and is an independent risk factor for falls, cardiovascular events, stroke and death. The primary aim of this pilot study was to estimate the frequency of postprandial hypotension and evaluate the mechanisms underlying this condition in older survivors of an Intensive Care Unit (ICU). MATERIALS AND METHODS Thirty-five older (>65 years) survivors were studied 3 months after discharge. After an overnight fast, participants consumed a 300 mL drink containing 75 g glucose, labelled with 20 MBq 99mTc-calcium phytate. Patients had concurrent measurements of blood pressure, heart rate, blood glucose and gastric emptying following drink ingestion. Proportion of participants is presented as percent (95% CI) and continuous variables as mean (SD). RESULTS Postprandial hypotension was evident in 10 (29%; 95% CI 14-44), orthostatic hypotension in 2 (6%; 95% CI 0-13) and cardiovascular autonomic dysfunction in 2 (6%; 95% CI 0-13) participants. The maximal postprandial nadir for systolic blood pressure and diastolic blood pressures were -29 (14) mmHg and -18 (7) mmHg. CONCLUSIONS In this cohort of older survivors of ICU postprandial hypotension occurred frequently . This suggests that postprandial hypotension is an unrecognised issue in older ICU survivors.
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Affiliation(s)
- Thu Anh Ngoc Nguyen
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Yasmine Ali Abdelhamid
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia; Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Luke M Weinel
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Seva Hatzinikolas
- National Health and Medical Research Council Centre for Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia
| | - Palash Kar
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | | | - Liza K Phillips
- National Health and Medical Research Council Centre for Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Michael Horowitz
- National Health and Medical Research Council Centre for Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Karen L Jones
- National Health and Medical Research Council Centre for Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Adam M Deane
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia; National Health and Medical Research Council Centre for Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia; Intensive Care Unit, Royal Melbourne Hospital, Parkville, Australia.
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Kramlich D. Complementary Health Practitioners in the Acute and Critical Care Setting: Nursing Considerations. Crit Care Nurse 2018; 37:60-65. [PMID: 28572102 DOI: 10.4037/ccn2017181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
In response to the rising demand by patients and their families for complementary health approaches, hospitals are increasingly integrating complementary health approaches with their conventional medical practices to create healing environments. Results of the 2010 Complementary and Alternative Medicine Survey of Hospitals indicated that the top 6 inpatient modalities included pet therapy, massage therapy, music or art therapy, guided imagery, relaxation therapy, and Reiki and therapeutic touch. Whether complementary health approaches are provided by complementary health practitioners through hospital-based integrative medicine programs, volunteer practitioners, or bedside nurses, the regulatory, legal, ethical, and safety concerns remain constant. Previous articles in this column of Critical Care Nurse provided an overview of complementary health approaches that nurses may encounter in their practices, with specific attention to implications for acute and critical care nurses, as well as important legal, ethical, safety, quality, and financial implications that acute and critical care nurses should consider when integrating complementary health approaches with conventional care. This column provides the acute and critical care nurse with key information about validation of credentials, experience, and competence of nurses and volunteers providing complementary health approaches, as well as about institutional policies and scope of practice.
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Affiliation(s)
- Debra Kramlich
- Debra Kramlich is an assistant professor of nursing, University of New England, Portland, Maine. She is also a traditional Usui Reiki master/teacher with more than 10 years of experience.
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Feeney C, Bruns E, LeCompte G, Forati A, Chen T, Matecki A. Acupuncture for Pain and Nausea in the Intensive Care Unit: A Feasibility Study in a Public Safety Net Hospital. J Altern Complement Med 2017; 23:996-1004. [DOI: 10.1089/acm.2016.0323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Colin Feeney
- Department of Internal Medicine, Highland General Hospital, Oakland, CA
| | - Elizabeth Bruns
- UC Berkeley–UC San Francisco Joint Medical Program, Berkeley, CA
| | | | - Anahita Forati
- Department of Internal Medicine, Highland General Hospital, Oakland, CA
| | - Thomas Chen
- Department of Internal Medicine, Highland General Hospital, Oakland, CA
| | - Amy Matecki
- Department of Internal Medicine, Highland General Hospital, Oakland, CA
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In Search of the Ideal Promotility Agent: Optimal Use of Currently Available Promotility Agents for Nutrition Therapy of the Critically Ill Patient. Curr Gastroenterol Rep 2017; 19:63. [PMID: 29143891 DOI: 10.1007/s11894-017-0604-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Enteral nutrition therapy is essential in the management of critically ill patients. Prokinetic agents have been used successfully to aid in the delivery of nutrition and improve feeding tolerance in patients in the intensive care unit (ICU). The aim of this report is to review the existing promotility agents available for use in the critically ill as well as outline the role of potential investigative drugs in order to provide a guide to the management of this difficult and important clinical dilemma. RECENT FINDINGS While no single currently available agent currently meets all of the desired goals in the critical care setting, there are an increasing number of available agents from which to choose including motilin receptor agonists, 5HT4 receptor agonists, D2 receptor antagonists, and Mu opioid receptor antagonists. We recommend a multifaceted approach to optimizing enteral nutrition in the critical care setting which should include the early, prophylactic use of promotility agents and should focus on the management of reversible causes of impaired gastrointestinal motility.
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Xiaoyong W, Xuzhao L, Deliang Y, Pengfei Y, Zhenning H, Bin B, Zhengyan L, Fangning P, Shiqi W, Qingchuan Z. Construction of a model predicting the risk of tube feeding intolerance after gastrectomy for gastric cancer based on 225 cases from a single Chinese center. Oncotarget 2017; 8:99940-99949. [PMID: 29245951 PMCID: PMC5725142 DOI: 10.18632/oncotarget.21966] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/20/2017] [Indexed: 12/27/2022] Open
Abstract
Identifying patients at high risk of tube feeding intolerance (TFI) after gastric cancer surgery may prevent the occurrence of TFI; however, a predictive model is lacking. We therefore analyzed the incidence of TFI and its associated risk factors after gastric cancer surgery in 225 gastric cancer patients divided into without-TFI (n = 114) and with-TFI (n = 111) groups. A total of 49.3% of patients experienced TFI after gastric cancer. Multivariate analysis identified a history of functional constipation (FC), a preoperative American Society of Anesthesiologists (ASA) score of III, a high pain score at 6-hour postoperation, and a high white blood cell (WBC) count on the first day after surgery as independent risk factors for TFI. The area under the curve (AUC) was 0.756, with an optimal cut-off value of 0.5410. In order to identify patients at high risk of TFI after gastric cancer surgery, we constructed a predictive nomogram model based on the selected independent risk factors to indicate the probability of developing TFI. Use of our predictive nomogram model in screening, if a probability > 0.5410, indicated a high-risk patients would with a 70.1% likelihood of developing TFI. These high-risk individuals should take measures to prevent TFI before feeding with enteral nutrition.
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Affiliation(s)
- Wu Xiaoyong
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China.,Department of Hepatobiliary Surgery, Shanxi Provincial People's Hospital, 030012, Taiyuan, Shanxi, China
| | - Li Xuzhao
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Yu Deliang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Yu Pengfei
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Hang Zhenning
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Bai Bin
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Li Zhengyan
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Pang Fangning
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Wang Shiqi
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Zhao Qingchuan
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
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Electroacupuncture Improves Gastric Emptying in Critically Ill Neurosurgical Patients: A Pilot Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:1892161. [PMID: 29234370 PMCID: PMC5632480 DOI: 10.1155/2017/1892161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/17/2017] [Indexed: 12/26/2022]
Abstract
Objective To compare the efficacy of combined electroacupuncture and metoclopramide treatment with that of metoclopramide only in improving gastric emptying in critically ill neurosurgical patients. Methods In this prospective case-control pilot study, a total of 16 adult critically ill mechanically ventilated patients who were treated in the surgical intensive care unit were enrolled. Electrical stimulation was applied to 4 pairs of points (maximum intensity < 9.8 mA at 2 Hz). Patients in the control group received standard treatment with intravenous metoclopramide only. Patients in the experimental group received intravenous metoclopramide plus electroacupuncture treatment once daily for 6 consecutive days. Results Gastric residual volume in the experimental group (n = 7) reduced gradually until the fourth day after treatment with electroacupuncture combined with routine metoclopramide administration. Beginning on the fourth day, residual volume was maintained at less than 200 ml per day for the following two days. In the control group (n = 9), there was a gradual reduction in residual volume during the first four days followed by a rebounding increase over the next two days. Conclusions Electroacupuncture combined with intravenous metoclopramide is a more effective treatment for gastric emptying than metoclopramide alone in adult critically ill patients with impaired brain function.
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15
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Karst M, Fink M. Acupuncture—A Biomedical Information Therapy: A Translational Analysis. Med Acupunct 2016. [DOI: 10.1089/acu.2016.1196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Matthias Karst
- Pain Clinic, Department of Anesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Matthias Fink
- Department of Physical Medicine and Rehabilitation, Hannover Medical School, Hannover, Germany
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16
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Al-Dorzi HM, Albarrak A, Ferwana M, Murad MH, Arabi YM. Lower versus higher dose of enteral caloric intake in adult critically ill patients: a systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:358. [PMID: 27814776 PMCID: PMC5097427 DOI: 10.1186/s13054-016-1539-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/20/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND There is conflicting evidence about the relationship between the dose of enteral caloric intake and survival in critically ill patients. The objective of this systematic review and meta-analysis is to compare the effect of lower versus higher dose of enteral caloric intake in adult critically ill patients on outcome. METHODS We reviewed MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus from inception through November 2015. We included randomized and quasi-randomized studies in which there was a significant difference in the caloric intake in adult critically ill patients, including trials in which caloric restriction was the primary intervention (caloric restriction trials) and those with other interventions (non-caloric restriction trials). Two reviewers independently extracted data on study characteristics, caloric intake, and outcomes with hospital mortality being the primary outcome. RESULTS Twenty-one trials mostly with moderate bias risk were included (2365 patients in the lower caloric intake group and 2352 patients in the higher caloric group). Lower compared with higher caloric intake was not associated with difference in hospital mortality (risk ratio (RR) 0.953; 95 % confidence interval (CI) 0.838-1.083), ICU mortality (RR 0.885; 95 % CI 0.751-1.042), total nosocomial infections (RR 0.982; 95 % CI 0.878-1.077), mechanical ventilation duration, or length of ICU or hospital stay. Blood stream infections (11 trials; RR 0.718; 95 % CI 0.519-0.994) and incident renal replacement therapy (five trials; RR 0.711; 95 % CI 0.545-0.928) were lower with lower caloric intake. The associations between lower compared with higher caloric intake and primary and secondary outcomes, including pneumonia, were not different between caloric restriction and non-caloric restriction trials, except for the hospital stay which was longer with lower caloric intake in the caloric restriction trials. CONCLUSIONS We found no association between the dose of caloric intake in adult critically ill patients and hospital mortality. Lower caloric intake was associated with lower risk of blood stream infections and incident renal replacement therapy (five trials only). The heterogeneity in the design, feeding route and timing and caloric dose among the included trials could limit our interpretation. Further studies are needed to clarify our findings.
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Affiliation(s)
- Hasan M Al-Dorzi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Intensive Care Department, King Abdulaziz Medical City, P.O. Box 22490, Riyadh, 11426, Saudi Arabia
| | | | - Mazen Ferwana
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Family Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,National & Gulf Center for Evidence Based Health Practice, Riyadh, 11426, Saudi Arabia
| | - Mohammad Hassan Murad
- Center for Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA.,Preventive Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Yaseen M Arabi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. .,Intensive Care Department, King Abdulaziz Medical City, P.O. Box 22490, Riyadh, 11426, Saudi Arabia.
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17
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Ko SJ, Kuo B, Kim SK, Lee H, Kim J, Han G, Kim J, Kim SY, Jang S, Son J, Kim M, Lee H, Yeo I, Joo KR, Park JW. Individualized Acupuncture for Symptom Relief in Functional Dyspepsia: A Randomized Controlled Trial. J Altern Complement Med 2016; 22:997-1006. [PMID: 27732083 DOI: 10.1089/acm.2016.0208] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES This study was implemented to evaluate the effect of individualized acupuncture treatment (AT) on functional dyspepsia (FD). METHODS A randomized, waitlist-controlled, two-center trial was performed. Seventy-six patients with FD were enrolled in the trial with partially individualized AT in a more realistic clinical setting performed twice a week for 15 minutes a session over 4 weeks. The participants were randomly allocated to a group receiving 8 sessions of AT for 4 weeks or a waitlist control group. After 4 consecutive weeks, the AT group was followed up without AT and the control group received the identical AT. The proportion of responders with adequate symptom relief, Nepean Dyspepsia Index (NDI), FD-related quality of life, Beck Depression Inventory, State-Trait Anxiety Inventory, Acupuncture Belief Scale, and acupuncture credibility test were assessed. RESULTS After the first 4 weeks, the proportion of responders significantly improved (59% in AT group [n = 37] versus 3% in control group [n = 39]; p < 0.001). The difference was no longer significant at 8 weeks, at which point the waitlist control group showed similar improvement after receiving AT (68% in the AT group versus 79% in the control group). Total NDI scores were significantly reduced in the AT group compared with the waitlist group (p = 0.03). Among NDI items, discomfort (p = 0.01), burning (p = 0.02), fullness after eating (p = 0.02), and burping (p = 0.02) were significantly improved in the AT group compared with the control group. No significant differences were observed between groups in other secondary variables. CONCLUSION Individualized AT adequately relieves symptoms in patients with FD, and this effect may persist up to 8 weeks.
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Affiliation(s)
- Seok-Jae Ko
- 1 Department of Gastroenterology, College of Korean Medicine, Kyung Hee University , Seoul, Republic of Korea
| | - Braden Kuo
- 2 Department of Gastroenterology, Center for Neurointestinal Health , Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Seul-Ki Kim
- 1 Department of Gastroenterology, College of Korean Medicine, Kyung Hee University , Seoul, Republic of Korea
| | - Hyangsook Lee
- 3 Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University , Seoul, Republic of Korea
| | - Jinsung Kim
- 1 Department of Gastroenterology, College of Korean Medicine, Kyung Hee University , Seoul, Republic of Korea
| | - Gajin Han
- 1 Department of Gastroenterology, College of Korean Medicine, Kyung Hee University , Seoul, Republic of Korea
| | - Juyeon Kim
- 1 Department of Gastroenterology, College of Korean Medicine, Kyung Hee University , Seoul, Republic of Korea
| | - Song-Yi Kim
- 3 Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University , Seoul, Republic of Korea
| | - Seungwon Jang
- 1 Department of Gastroenterology, College of Korean Medicine, Kyung Hee University , Seoul, Republic of Korea
| | - Jiyoung Son
- 1 Department of Gastroenterology, College of Korean Medicine, Kyung Hee University , Seoul, Republic of Korea
| | - Minji Kim
- 1 Department of Gastroenterology, College of Korean Medicine, Kyung Hee University , Seoul, Republic of Korea
| | - Hyejung Lee
- 3 Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University , Seoul, Republic of Korea
| | - Inkwon Yeo
- 4 Department of Statistics, Sookmyung Women's University , Seoul, Republic of Korea
| | - Kwang Ro Joo
- 5 Department of Gastroenterology, School of Medicine, Kyung Hee University , Seoul, Republic of Korea
| | - Jae-Woo Park
- 1 Department of Gastroenterology, College of Korean Medicine, Kyung Hee University , Seoul, Republic of Korea
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18
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Gupta E, Lee LA. Diet and Complementary Medicine for Chronic Unexplained Nausea and Vomiting and Gastroparesis. ACTA ACUST UNITED AC 2016; 14:401-409. [DOI: 10.1007/s11938-016-0104-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Huang Z, Zhang N, Xu F, Yin J, Dai N, Chen JDZ. Ameliorating effect of transcutaneous electroacupuncture on impaired gastric accommodation induced by cold meal in healthy subjects. J Gastroenterol Hepatol 2016; 31:561-6. [PMID: 26399958 DOI: 10.1111/jgh.13168] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 08/10/2015] [Accepted: 09/03/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Impaired gastric accommodation is recognized as one of major pathophysiologies in functional dyspepsia and gastroparesis. Electroacupuncture has been shown to improve gastric accommodation in laboratory settings. It is, however, unknown whether it exerts similar ameliorating effect in humans and whether needleless transcutaneous electroacupuncture (TEA) is also effective in improving gastric accommodation. AIM The aim was to investigate the effects of TEA on gastric accommodation, gastric slow waves, and dyspeptic related symptoms. METHODS Thirteen healthy volunteers were studied in four randomized sessions: control, cold nutrient liquid, cold nutrient liquid + sham-TEA, and cold nutrient liquid + TEA. The subjects were requested to drink Ensure until reaching maximum satiety. The electrogastrogram (EGG) and electrocardiogram (ECG) were recorded to assess the gastric and autonomic functions respectively. RESULTS 1) Gastric accommodation was reduced with the cold drink in comparison with the warm drink (P = 0.023). TEA improved the impaired gastric accommodation from 539.2 ± 133.8 ml to 731.0 ± 185.7 ml (P = 0.005). 2) The percentage of normal gastric slow waves in six subjects was significantly decreased in the cold session (P = 0.002) and improved in the TEA session (P = 0.009 vs sham; P < 0.001 vs cold). 3) TEA showed significant improvement in the bloating (80.8 ± 5.7 vs 61.2 ± 26.2, P = 0.011), postprandial fullness (48.1 ± 12.0 vs 34.2 ± 21.2, P = 0.042), and nausea (29.6 ± 10.9 vs 19.2 ± 11.2, P = 0.026) in comparison with sham-TEA session. 4) Neither cold drink nor TEA altered vagal activities (P > 0.05). CONCLUSIONS TEA improves impaired gastric accommodation and slow waves induced by cold drink and the effect does not seem to be mediated via the vagal mechanisms.
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Affiliation(s)
- Zhihui Huang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Ningbo Pace Translational Medical Research Center, Ningbo, China
| | - Nina Zhang
- Ningbo Pace Translational Medical Research Center, Ningbo, China
| | - Feng Xu
- Department of Gastroenterology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, China
| | - Jieyun Yin
- Ningbo Pace Translational Medical Research Center, Ningbo, China.,Johns Hopkins Center for Neurogastroenterology, Johns Hopkins University, Baltimore, USA
| | - Ning Dai
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiande D Z Chen
- Ningbo Pace Translational Medical Research Center, Ningbo, China.,Johns Hopkins Center for Neurogastroenterology, Johns Hopkins University, Baltimore, USA
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20
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Japanese Guidelines for Nutrition Support Therapy in the Adult and Pediatric Critically Ill Patients. ACTA ACUST UNITED AC 2016. [DOI: 10.3918/jsicm.23.185] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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21
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Electroacupuncture at Zusanli Prevents Severe Scalds-Induced Gut Ischemia and Paralysis by Activating the Cholinergic Pathway. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:787393. [PMID: 26448777 PMCID: PMC4581501 DOI: 10.1155/2015/787393] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/24/2015] [Accepted: 08/30/2015] [Indexed: 02/07/2023]
Abstract
Severe burn injuries may result in gastrointestinal paralysis, and barrier dysfunction due to gut ischemia and lowered vagus excitability. In this study we investigate whether electroacupuncture (EA) at Zusanli (ST36) could prevent severe scalds-induced gut ischemia, paralysis, and barrier dysfunction and whether the protective role of EA at ST36 is related to the vagus nerve. 35% burn area rats were divided into six groups: (a) EAN: EA nonchannel acupoints followed by scald injury; (b) EA: EA at ST36 after scald injury; (c) VGX/EA: vagotomy (VGX) before EA at ST36 and scald injury; (d) VGX/EAN: VGX before EAN and scald injury; (e) atropine/EA: applying atropine before scald injury and then EA at ST36; (f) atropine/EAN: applying atropine before scald injury and then EA at nonchannel acupoints. EA at the Zusanli point significantly promoted the intestinal impelling ratio and increased the amount of mucosal blood flow after scald injury. The plasma diamine oxidase (DAO) and intestinal permeability decreased significantly after scald injury in the EA group compared with others. However, EA after atropine injection or cervical vagotomy failed to improve intestinal motility and mucosa blood flow suggesting that the mechanism of EA may be related to the activation of the cholinergic nerve pathway.
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Lee LA, Chen J, Yin J. Complementary and alternative medicine for gastroparesis. Gastroenterol Clin North Am 2015; 44:137-50. [PMID: 25667029 DOI: 10.1016/j.gtc.2014.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Complementary and alternative medicine is of great interest to patients with gastrointestinal disorders and some will choose to ask their health care providers about those therapies for which some scientific evidence exists. This review focuses on those therapies most commonly used by patients, namely acupuncture/electroacupuncture and various herbal formulations that have been the focus of clinical and laboratory investigation. A discussion of their possible mechanisms of action and the results of clinical studies are summarized.
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Affiliation(s)
- Linda A Lee
- Division of Gastroenterology and Hepatology, Johns Hopkins Integrative Medicine & Digestive Center, Johns Hopkins University School of Medicine, 2360 West Joppa Road, Suite 200, Lutherville, MD 20193, USA.
| | - Jiande Chen
- Clinical Motility Lab, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, A-505, Baltimore, MD 21224, USA
| | - Jieyun Yin
- Veterans Research and Education Foundation, VA Medical Center, 921 NE 13th Street, Oklahoma City, OK 73104, USA
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23
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Grundmann O, Yoon SL, Williams JJ. Influence of Acupuncture on Bioelectrical Impedance Measures in Patients with Gastrointestinal Cancer: Results of a Pilot Study. Acupunct Med 2015; 33:16-22. [DOI: 10.1136/acupmed-2014-010667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Patients with gastrointestinal cancers often suffer from malnutrition and cachexia caused by inflammatory processes due to malignancy and therapeutic intervention. Evaluation of nutritional status and well-being of patients is essential to prevent or slow down the progression of cachexia. In addition, acupuncture as a complementary intervention may help reduce cachexia and unintentional weight loss. Methods Seven patients with cancers of the gastrointestinal tract enrolled in this pilot study were provided with eight acupuncture sessions in addition to their regular treatment schedule. Bioelectrical impedance analysis (BIA) measurements were taken at every other acupuncture session to evaluate the body composition of patients. BIA is a fast, inexpensive and non-invasive method for evaluating fluid, fat and muscle mass distribution which correlates with nutritional status. Results All patients enrolled in the pilot study completed the acupuncture intervention and BIA measurements. The average weight loss and reduction in body weight was 1.3%, which is less than the average weight loss of 5% reported in the literature. Both phase angle and fat-free mass decreased in patients, indicating a worsening of the condition. However, a shift from intracellular to extracellular fluid was not observed, which is usually associated with a loss of cell integrity. Conclusions This pilot study indicates that patients tolerate acupuncture treatments well. The BIA results should be interpreted with caution due to the small sample size. A larger randomised placebo-controlled study is currently being conducted to further investigate the influence of acupuncture and to provide insights into BIA as a reliable tool for evaluating body composition in patients with gastrointestinal cancers.
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Affiliation(s)
- Oliver Grundmann
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Department of Adult and Elderly Nursing, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Saunjoo L Yoon
- Department of Adult and Elderly Nursing, College of Nursing, University of Florida, Gainesville, Florida, USA
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Reintam Blaser A, Starkopf L, Deane AM, Poeze M, Starkopf J. Comparison of different definitions of feeding intolerance: A retrospective observational study. Clin Nutr 2014; 34:956-61. [PMID: 25467878 DOI: 10.1016/j.clnu.2014.10.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 10/07/2014] [Accepted: 10/21/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS While feeding intolerance (FI) is clinically important in the critically ill it is inconsistently defined. By evaluating definitions of FI based on relationships between symptoms and signs of gastrointestinal (GI) dysfunction and mortality the objective was to define FI using the definition that was most strongly associated with subsequent mortality. METHODS Data from all adult patients admitted to a single ICU between 2004 and 2011, and who were receiving enteral nutrition (EN), were analysed. The amount of EN administered, presence of absent bowel sounds (BS), vomiting and/or regurgitation, diarrhoea, bowel distension, and large gastric residual volumes (GRVs) were documented daily. A GRV ≥500 ml/day was considered as large and the sum of gastrointestinal (GI) symptoms including large GRV was calculated daily. Various definitions of FI were modelled. Definitions using only GRV, or GRV with other GI symptoms, or GRV and failure to reach preset EN targets were evaluated. The predictive power of FI on mortality was tested by adding the presence of FI (different definitions were tested one-by-one) into multiple regression analyses together with admission day demographic and severity of illness variables. RESULTS Of the 1712 patients included, 221 (12.9%) died in ICU and 495 (28.9%) had died within 90 days after ICU admission. The definition of FI based on the presence of at least three out of five GI symptoms was most strongly related to ICU-mortality (6.3% prevalence in survivors vs. 23.5% in non-survivors, p < 0.001, odds ratio (95%CI) 3.39 (2.23-5.14)), whereas EN <23% of caloric target was the strongest predictor for mortality 90 days after admission (50.7% prevalence among survivors vs 75.2% in non-survivors, p < 0.001, odds ratio (95% CI) 2.34 (1.80-3.04)). CONCLUSIONS FI is associated with increased mortality but the strength of this relationship depends on the definition used. The 'best' definition of FI for prediction of ICU-mortality is based on a complex assessment of GI symptoms (including large GRV), whereas enteral underfeeding is the definition of FI that is the strongest predictor of death within 90 days of admission. Our 'best' definitions are not immediately generalizable, but should help building up future studies.
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Affiliation(s)
- Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Puusepa 8, Tartu 51014, Estonia; Department of Anaesthesiology and Intensive Care Medicine, Lucerne Cantonal Hospital, Spitalstrasse, 6000 Lucerne 16, Switzerland.
| | - Liis Starkopf
- Department of Anaesthesiology and Intensive Care, University of Tartu, Puusepa 8, Tartu 51014, Estonia; Faculty of Mathematics and Computer Science, University of Tartu, J. Liivi 2, Tartu 50409, Estonia.
| | - Adam M Deane
- Discipline of Acute Care Medicine, University of Adelaide, Level 5, Eleanor Harrald Building, Frome St, Adelaide SA 5000, Australia; Department of Critical Care Services, Royal Adelaide Hospital, North Terrace, Adelaide SA 5000, Australia.
| | - Martijn Poeze
- Department of Surgery/Intensive Care Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, Netherlands.
| | - Joel Starkopf
- Department of Anaesthesiology and Intensive Care, University of Tartu, Puusepa 8, Tartu 51014, Estonia; Department of Anaesthesiology and Intensive Care, Tartu University Clinics, Puusepa 1A, Tartu 51014, Estonia.
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25
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Cheong KB, Zhang JP, Huang Y. The effectiveness of acupuncture in postoperative gastroparesis syndrome--a systematic review and meta-analysis. Complement Ther Med 2014; 22:767-86. [PMID: 25146082 DOI: 10.1016/j.ctim.2014.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 04/15/2014] [Accepted: 05/04/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Postoperative gastroparesis syndrome (PGS) which is mainly manifested as delayed gastric emptying is often caused by upper abdominal and sometimes lower abdominal surgery. In view of the side effects of drugs therapy, the search of supplementary and alternative has been of increasing interest. OBJECTIVE This paper included a systematic review and meta-analysis on the use of acupuncture and acupoints selection in PGS. Quality for meta-analysis was evaluated using GRADE while each trial was assessed with CONSORT and STRICTA for TCM. METHODS Randomized controlled trials (RCTs) comparing acupuncture with non-acupuncture treatment were identified from databases PubMed, EBSCO, Ovid, Cochrane, CNKI and Wanfangdata. Meta-analysis on eligible studies was performed using fixed-effects model with RevMan 5.2. Results were expressed as relative risk (RR) for dichotomous data, and 95% confidence interval (CI) were calculated. RESULTS Of the 348 studies reviewed, 16 RCTs met the inclusion criteria for review while 7 RCTs, 188 patients (intervention) and 182 patients (control) met the criteria for meta-analysis. Both acupuncture and acupuncture combined with medication showed significant higher total effective rate than control (usual care/medication); with (RR 1.27, 95% CI 1.13, 1.44; P<0.0001) and (RR 1.37, 95% CI 1.18, 1.58; P<0.0001) respectively. All included RCTs reported positive effect of acupuncture in PGS treatment. ST36, CV12 and PC6 seemed to be the common acupoints selected. CONCLUSIONS The results suggested acupuncture might be effective to improve PGS, however, a definite conclusion could not be drawn due to low quality of trials. Further large-scale, high-quality randomized clinical trials are needed to validate this. STUDY REGISTRATION PROSPERO CRD42013005485.
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Affiliation(s)
- Kah Bik Cheong
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Ji-ping Zhang
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Yong Huang
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, Guangdong, China.
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Abstract
Gastroesophageal reflux (GER) is a common occurrence in critically ill, mechanically ventilated patients. Reflux can lead to pulmonary aspiration of gastric contents and subsequent pneumonia. Several characteristics of patients, interventions provided in the intensive care unit setting, and factors associated with feeding increase a patient's risk for reflux. Critical care nurses and clinical nurse specialists can identify patients at highest risk for GER by utilizing the patient's history, reviewing the medications, and assessing the current status to provide interventions to reduce the risk of GER and its sequelae of aspiration pneumonia. This article reviews the physiology of GER, risk factors, and interventions to decrease GER in the critically ill patient.
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Abstract
PURPOSE OF REVIEW Gastrointestinal dysmotility and dysfunction underlie our difficulties in providing adequate nutrition by the enteral route to our critically ill patients. RECENT FINDINGS Recent studies have quantified gastric emptying and nutrient absorption. Slow gastric emptying is common and probably mediated by cholecystokinin and reduced active ghrelin concentrations. The cause of impaired nutrient absorption is not yet fully understood but may be related to small intestinal blood flow and/or mucosal factors. The absorption of the different macronutrients may be affected in different ways both by critical illness and by therapies. A better understanding of this may optimize the design of nutrient formulations in the future. New treatment modalities for gastrointestinal dysfunction are being investigated and include small intestinal feeding, nonpharmacological options such as acupuncture, and drugs including novel motilin receptor agonists, and opioid antagonists. SUMMARY We are gradually developing a better understanding of how the gut works during critical illness, which has implications for optimizing the delivery of nutrition and thereby improving nutritional and clinical outcomes.
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Affiliation(s)
- Marianne J Chapman
- Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
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Abstract
Severe traumatic brain injury ranks among the most common causes of death in young adults in western countries. Severe traumatic brain injury is typically followed by a pronounced pathophysiological cascade that accounts for many deaths. The aim of intensive care medicine after traumatic brain injury is to minimize and to control the consequences of this potentially fatal cascade. The avoidance of hypoxemia, arterial hypotension, intracranial hypertension, hyperthermia, hyperglycemia, hypoglycemia and thromboembolic complications is essential in preventing this cascade. The effect of nutrition has been rather underestimated as a means of improving the outcome after traumatic brain injury. Nutrition should be started within the first 24 h after trauma. Enteral, wherever applicable, should be the route of administration of nutrition. Enteral administration of the whole calculated calorie requirement on day 1 after trauma, if possible, lowers the infection and overall complication rates. The present review gives an update of a practical approach to nutrition in traumatic brain injury.
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Berger MM, Pichard C. Best timing for energy provision during critical illness. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:215. [PMID: 22429787 PMCID: PMC3681360 DOI: 10.1186/cc11229] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Mette M Berger
- Service of Intensive Care Medicine & Burns, CHUV, Lausanne, Switzerland.
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Ho VK, Ong S, Cui S, Hwang NC. Preliminary Report on Efficacy of Acupuncture versus meToclopramide for Management of Post-Operative Gastroparesis (EAT POSTOP Trial). PROCEEDINGS OF SINGAPORE HEALTHCARE 2012. [DOI: 10.1177/201010581202100303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Gastroparesis is common in intensive care patients and may increase the incidence of malnutrition and nosocomial pneumonia, leading to poorer patient outcomes. Current pharmacotherapy has shown only modest efficacy. Acupuncture without pharmacotherapy has been shown to improve gastroparesis in animal studies and in recent clinical trials. However, no trials studying the efficacy of acupuncture as an adjunctive therapy for surgical intensive care patients have been done. This study aims to evaluate the effectiveness of adding electro-acupuncture therapy to pharmacotherapy in the management of gastroparesis in these patients. Methods: For this prospective block randomised controlled trial, we aim to recruit 200 adult surgical intensive care patients who require gastric enteral nutrition, and mechanical-assisted ventilation, and who have gastroparesis (gastric residual volumes more than 120 mL twice four hours apart). Patients will receive either metoclopramide 20 mg intravenously thrice daily (Group M) or electro-acupuncture comprising four sessions of 30-minute electro-acupuncture at specific sites over 48 hours in addition to intravenous metoclopramide 20 mg thrice daily (Group A). Gastroparesis resolution is defined as 24-hour cumulative gastric residual volumes less than 200 mL. Patients are followed-up for 48 hours from the commencement of therapy. Results: Three patients have been recruited in a four-month period thus far. Two are in Group A and one in Group M. All have met the study definition of gastroparesis resolution. The incidence of gastroparesis in this period among longer stayers in the unit (n = 92) is 8.7%. Conclusions: The trial is on-going. Reasons for the low incidence of gastroparesis are discussed. The study of the use of acupuncture in the treatment of intensive care patients with gastroparesis is worthwhile due to its excellent side-effect profile and if successful, will be a tool to improve nutritional support.
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Affiliation(s)
- Vui Kian Ho
- Department of Anaesthesiology, Singapore General Hospital
| | - Sharon Ong
- Department of Anaesthesiology, Singapore General Hospital
| | - Shuli Cui
- Senior Principal Acupuncturist, Singapore General Hospital
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Pfab F, Kirchner MT, Huss-Marp J, Schuster T, Schalock PC, Fuqin J, Athanasiadis GI, Behrendt H, Ring J, Darsow U, Napadow V. Acupuncture compared with oral antihistamine for type I hypersensitivity itch and skin response in adults with atopic dermatitis: a patient- and examiner-blinded, randomized, placebo-controlled, crossover trial. Allergy 2012; 67:566-73. [PMID: 22313287 DOI: 10.1111/j.1398-9995.2012.02789.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND Itch is the major symptom of atopic dermatitis (AD). Acupuncture has been shown to exhibit a significant effect on experimental itch in AD. Our study evaluated acupuncture and antihistamine itch therapy (cetirizine) on type I hypersensitivity itch and skin reaction in AD using a patient and examiner-blinded, randomized, placebo-controlled, crossover trial. METHODS Allergen-induced itch was evaluated in 20 patients with AD after several interventions in separate sessions: preventive (preceding) and abortive (concurrent) verum acupuncture (VAp and VAa), cetirizine (10 mg, VC), corresponding placebo interventions (preventive, PAp, and abortive, PAa, placebo acupuncture; placebo cetirizine pill, PC) and a no-intervention control (NI). Itch was induced on the forearm and temperature modulated over 20 min, using our validated model. Outcome parameters included itch intensity, wheal and flare size and the D2 attention test. RESULTS Mean itch intensity (SE: 0.31 each) was significantly lower following VAa (31.9) compared with all other groups (PAa: 36.5; VC: 36.8; VAp: 37.6; PC: 39.8; PAp: 39.9; NI: 45.7; P < 0.05). There was no significant difference between VAp and VC (P > 0.1), although both therapies were significantly superior to their respective placebo interventions (P < 0.05). Flare size following VAp was significantly smaller (P = 0.034) than that following PAp. D2 attention test score was significantly lower following VC compared with all other groups (P < 0.001). CONCLUSIONS Both VA and cetirizine significantly reduced type I hypersensitivity itch in patients with AD, compared with both placebo and NI. Timing of acupuncture application was important, as VAa had the most significant effect on itch, potentially because of counter-irritation and/or distraction. Itch reduction following cetirizine coincided with reduced attention.
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Affiliation(s)
| | - M.-T. Kirchner
- Division of Environmental Dermatology and Allergy; Helmholtz Zentrum München/TUM; ZAUM-Center for Allergy and Environment; Munich; Germany
| | | | - T. Schuster
- Institute for Medical Statistics and Epidemiology; Technische Universität München; Munich; Germany
| | - P. C. Schalock
- Department of Dermatology; Harvard Medical School; Massachusetts General Hospital; Boston; MA; USA
| | | | - G. I. Athanasiadis
- Department of Dermatology and Allergy; Technische Universität München; Munich; Germany
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Yu LN, Pei J. [Application of differential proteomics in mechanism research of acupuncture]. ACTA ACUST UNITED AC 2012; 9:819-23. [PMID: 21849141 DOI: 10.3736/jcim20110802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Proteomics, a new branch of science, has been used to study protein expressions on the molecular level with a dynamic perspective. Organisms under varying states may express different proteins, which results in the set-up of differential proteomics. Research methods of differential proteomics include the separation and identification of proteins. Differential proteomics has a rapid development in recent years. In the study of acupuncture, researchers have reached certain achievements using differential proteomics to investigate the mechanisms of acupuncture treatment for some diseases, including acute spinal cord injury, ischemic cerebrovascular disease, Parkinson's disease and neuralgia.
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Affiliation(s)
- Lin-na Yu
- Department of Acupuncture and Moxibustion, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
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Pfab F, Nowak-Machen M, Napadow V, Fleckenstein J. Alternatives to prokinetics to move the pylorus and colon. Curr Opin Clin Nutr Metab Care 2012; 15:166-73. [PMID: 22234164 DOI: 10.1097/mco.0b013e32834f3000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Gastrointestinal motility disorders (GMDs) are common in the ICU. When encountering these problems, one typically thinks of prokinetics. This review summarizes current evidence of treatments. RECENT FINDINGS Prokinetics are not the first-line therapy for GMDs. In fact, the clinical implications of using prokinetic agents are rather controversial. Current evidence on alternative treatment modalities such as fluid and electrolyte management, laxatives, opioid antagonists, purgative enemas, acupuncture, physical therapies and probiotics is growing. SUMMARY Current state of the art to treat GMDs is primarily focused at the elimination of underlying trigger factors. Fluid and electrolyte management as well as laxatives and peripherally acting μ-opioid receptor antagonists are the recommended first-line therapies that can be complemented with prokinetics. Acupuncture as well as physical modalities, such as massage or warming of the abdomen, is promising with few side-effects and should be considered as well.
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Affiliation(s)
- Florian Pfab
- Department of Preventive and Rehabilitative Sports Medicine, Technische Universität München, Munich, Germany.
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Reintam Blaser A, Malbrain MLNG, Starkopf J, Fruhwald S, Jakob SM, De Waele J, Braun JP, Poeze M, Spies C. Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Med 2012; 38:384-94. [PMID: 22310869 PMCID: PMC3286505 DOI: 10.1007/s00134-011-2459-y] [Citation(s) in RCA: 312] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 12/20/2011] [Indexed: 12/11/2022]
Abstract
PURPOSE Acute gastrointestinal (GI) dysfunction and failure have been increasingly recognized in critically ill patients. The variety of definitions proposed in the past has led to confusion and difficulty in comparing one study to another. An international working group convened to standardize the definitions for acute GI failure and GI symptoms and to review the therapeutic options. METHODS The Working Group on Abdominal Problems (WGAP) of the European Society of Intensive Care Medicine (ESICM) developed the definitions for GI dysfunction in intensive care patients on the basis of the available evidence and current understanding of the pathophysiology. RESULTS Definitions for acute gastrointestinal injury (AGI) with its four grades of severity, as well as for feeding intolerance syndrome and GI symptoms (e.g. vomiting, diarrhoea, paralysis, high gastric residual volumes) are proposed. AGI is a malfunctioning of the GI tract in intensive care patients due to their acute illness. AGI grade I = increased risk of developing GI dysfunction or failure (a self-limiting condition); AGI grade II = GI dysfunction (a condition that requires interventions); AGI grade III = GI failure (GI function cannot be restored with interventions); AGI grade IV = dramatically manifesting GI failure (a condition that is immediately life-threatening). Current evidence and expert opinions regarding treatment of acute GI dysfunction are provided. CONCLUSIONS State-of-the-art definitions for GI dysfunction with gradation as well as management recommendations are proposed on the basis of current medical evidence and expert opinion. The WGAP recommends using these definitions for clinical and research purposes.
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Affiliation(s)
- Annika Reintam Blaser
- Clinic of Anaesthesiology and Intensive Care, University of Tartu, Puusepa 8, 51014 Tartu, Estonia.
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Nutritional support in critically ill patients: can we have the cake and the topping too? Crit Care Med 2012; 39:2757-9. [PMID: 22094503 DOI: 10.1097/ccm.0b013e31822a5c47] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Garza Villarreal EA, Brattico E, Vase L, Østergaard L, Vuust P. Superior analgesic effect of an active distraction versus pleasant unfamiliar sounds and music: the influence of emotion and cognitive style. PLoS One 2012; 7:e29397. [PMID: 22242169 PMCID: PMC3252324 DOI: 10.1371/journal.pone.0029397] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 11/28/2011] [Indexed: 11/18/2022] Open
Abstract
Listening to music has been found to reduce acute and chronic pain. The underlying mechanisms are poorly understood; however, emotion and cognitive mechanisms have been suggested to influence the analgesic effect of music. In this study we investigated the influence of familiarity, emotional and cognitive features, and cognitive style on music-induced analgesia. Forty-eight healthy participants were divided into three groups (empathizers, systemizers and balanced) and received acute pain induced by heat while listening to different sounds. Participants listened to unfamiliar Mozart music rated with high valence and low arousal, unfamiliar environmental sounds with similar valence and arousal as the music, an active distraction task (mental arithmetic) and a control, and rated the pain. Data showed that the active distraction led to significantly less pain than did the music or sounds. Both unfamiliar music and sounds reduced pain significantly when compared to the control condition; however, music was no more effective than sound to reduce pain. Furthermore, we found correlations between pain and emotion ratings. Finally, systemizers reported less pain during the mental arithmetic compared with the other two groups. These findings suggest that familiarity may be key in the influence of the cognitive and emotional mechanisms of music-induced analgesia, and that cognitive styles may influence pain perception.
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Affiliation(s)
- Eduardo A. Garza Villarreal
- Center of Functionally Integrative Neuroscience, University of Aarhus, Aarhus, Denmark
- The Royal Academy of Music, Aarhus and Aalborg, Denmark
- * E-mail:
| | - Elvira Brattico
- Cognitive Brain Research Unit, Cognitive Science, Institute of Behavioral Science, University of Helsinki & Centre of Excellence for Interdisciplinary Music Research, University of Jyväskylä, Jyväskylä, Finland
| | - Lene Vase
- Center of Functionally Integrative Neuroscience, University of Aarhus, Aarhus, Denmark
- Department of Psychology, University of Aarhus, and Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
| | - Leif Østergaard
- Center of Functionally Integrative Neuroscience, University of Aarhus, Aarhus, Denmark
- Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Vuust
- Center of Functionally Integrative Neuroscience, University of Aarhus, Aarhus, Denmark
- The Royal Academy of Music, Aarhus and Aalborg, Denmark
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