Impact of enteral feeding on gastric tonometry in healthy volunteers and critically ill patients

2001 ◽  
Vol 45 (5) ◽  
pp. 564-569 ◽  
Author(s):  
R. Rokyta Jr ◽  
I. Novák ◽  
M. Matějovič ◽  
P. Hora ◽  
M. Nalos ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Critically Ill ◽  
Enteral Feeding ◽  
Critically Ill Patients ◽  
Gastric Tonometry

Gastric Tonometry and Enteral Nutrition: a Possible Conflict in Critical Care Nursing Practice

2003 ◽  
Vol 12 (4) ◽  
pp. 349-356 ◽  
Author(s):  
Andrea P. Marshall ◽  
Sandra H. West
Keyword(s):  
Carbon Dioxide ◽  
Critically Ill ◽  
Enteral Feeding ◽  
Critically Ill Patients ◽  
Empty Stomach ◽  
Gastric Tonometry ◽  
Initial Increase ◽  
Full Stomach ◽  
Mucosal Perfusion ◽  
Significant Difference

• Background Gastric tonometry is used to assess gastrointestinal mucosal perfusion in critically ill patients. However, enteral feeding is withheld during monitoring with gastric tonometry because enteral feeding is thought to influence tonometric measurements.• Objectives To examine the effect of enteral feeding on the tonometric measurement of gastric mucosal carbon dioxide.• Methods Gastric tonometers were placed in 20 critically ill patients, and the Pco2 of the gastric mucosa was measured in both the full and the empty stomach during a 48-hour period.• Results The Pco2 measured by the tonometer increased after enteral feeding, and a significant difference in the Pco2 of the full versus the empty stomach was evident at 24 and 48 hours. Pco2 at 4, 24, and 48 hours differed significantly in the full stomach and in the empty stomach. However, the data did not reveal a significant difference in either the full stomach or the empty stomach between Pco2 at 24 hours and Pco2 at 48 hours.• Conclusion After 24 hours of feeding, the initial increase in Pco2 observed at 4 hours was not evident, suggesting stabilization of the intragastric environment. However, a higher Pco2 was evident in the empty stomach, indicating that the presence of the feeding solution may reduce the diffusion of carbon dioxide into the tonometer balloon. Consequently, measurements of intragastric Pco2 obtained after 24 hours of feeding may be reliable if the stomach is emptied by aspiration via the tonometer immediately before measurement.

scholarly journals Effectiveness of enteral feeding protocol on clinical outcomes in critically ill patients: A before and after study

PLoS ONE ◽  
2017 ◽  
Vol 12 (8) ◽  
pp. e0182393 ◽  
Author(s):  
Qian Li ◽  
Zhongheng Zhang ◽  
Bo Xie ◽  
Xiaowei Ji ◽  
Jiahong Lu ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Critically Ill ◽  
Enteral Feeding ◽  
Critically Ill Patients ◽  
Before And After ◽  
Before And After Study ◽  
Feeding Protocol

scholarly journals Immune Profiling Panel: A Proof-of-Concept Study of a New Multiplex Molecular Tool to Assess the Immune Status of Critically Ill Patients

2020 ◽  
Vol 222 (Supplement_2) ◽  
pp. S84-S95
Author(s):  
Dina M Tawfik ◽  
Laurence Vachot ◽  
Adeline Bocquet ◽  
Fabienne Venet ◽  
Thomas Rimmelé ◽  
...  
Keyword(s):  
Septic Shock ◽  
Immune Response ◽  
Healthy Volunteers ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Messenger Rna ◽  
Immune Status ◽  
Quantitative Polymerase Chain Reaction ◽  
Coefficient Of Determination ◽  
Immune Profiling

Abstract Background Critical illness such as sepsis is a life-threatening syndrome defined as a dysregulated host response to infection and is characterized by patients exhibiting impaired immune response. In the field of diagnosis, a gap still remains in identifying the immune profile of critically ill patients in the intensive care unit (ICU). Methods A new multiplex immune profiling panel (IPP) prototype was assessed for its ability to semiquantify messenger RNA immune-related markers directly from blood, using the FilmArray System, in less than an hour. Samples from 30 healthy volunteers were used for the technical assessment of the IPP tool. Then the tool was clinically assessed using samples from 10 healthy volunteers and 20 septic shock patients stratified using human leukocyte antigen–DR expression on monocytes (mHLA-DR). Results The IPP prototype consists of 16 biomarkers that target the immune response. The majority of the assays had a linear expression with different RNA inputs and a coefficient of determination (R2) > 0.8. Results from the IPP pouch were comparable to standard quantitative polymerase chain reaction and the assays were within the limits of agreement in Bland–Altman analysis. Quantification cycle values of the target genes were normalized against reference genes and confirmed to account for the different cell count and technical variability. The clinical assessment of the IPP markers demonstrated various gene modulations that could distinctly differentiate 3 profiles: healthy volunteers, intermediate mHLA-DR septic shock patients, and low mHLA-DR septic shock patients. Conclusions The use of IPP showed great potential for the development of a fully automated, rapid, and easy-to-use immune profiling tool. The IPP tool may be used in the future to stratify critically ill patients in the ICU according to their immune status. Such stratification will enable personalized management of patients and guide treatments to avoid secondary infections and lower mortality.

scholarly journals Lactate kinetics in ICU patients using a bolus of 13C-labeled lactate

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Jonathan Grip ◽  
Tobias Falkenström ◽  
Panuwat Promsin ◽  
Jan Wernerman ◽  
Åke Norberg ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Bolus Dose ◽  
Trial Registration ◽  
Published Data ◽  
Metabolic Clearance ◽  
Icu Patients ◽  
Clinical Prognosis ◽  
Lactate Kinetics

Abstract Background Plasma lactate concentrations and their trends over time are used for clinical prognosis, and to guide treatment, in critically ill patients. Although heavily relied upon for clinical decision-making, lactate kinetics of these patients is sparsely studied. Aim To establish and validate a feasible method to study lactate kinetics in critically ill patients. Methods Healthy volunteers (n = 6) received a bolus dose of 13C-labeled lactate (20 μmol/kg body weight), and 43 blood samples were drawn over 2 h to determine the decay in labeled lactate. Data was analyzed using non-compartmental modeling calculating rates of appearance (Ra) and clearance of lactate. The area under the curve (AUC) was calculated using a linear-up log-down trapezoidal approach with extrapolation beyond 120 min using the terminal slope to obtain the whole AUC. After evaluation, the same protocol was used in an unselected group of critically ill patients (n = 10). Results Ra for healthy volunteers and ICU patients were 12.8 ± 3.9 vs 22.7 ± 11.1 μmol/kg/min and metabolic clearance 1.56 ± 0.39 vs 1.12 ± 0.43 L/min, respectively. ICU patients with normal lactate concentrations showed kinetics very similar to healthy volunteers. Simulations showed that reducing the number of samples from 43 to 14 gave the same results. Our protocol yielded results on lactate kinetics very similar to previously published data using other techniques. Conclusion This simple and user-friendly protocol using an isotopically labeled bolus dose of lactate was accurate and feasible for studying lactate kinetics in critically ill ICU patients. Trial registration ANZCTR, ACTRN12617000626369, registered 8 March 2017. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372507&isReview=true

Long-term Enteral Access in Aspiration-prone Patients

1995 ◽  
Vol 10 (4) ◽  
pp. 179-186 ◽  
Author(s):  
Alex C. Cech ◽  
Jon B. Morris ◽  
James L. Mullen ◽  
Gary W. Crooks
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Enteral Feeding ◽  
Critically Ill Patients ◽  
Nutrition Support ◽  
Enteral Access ◽  
Enteral Nutrition Support

Aspiration pneumonia is a serious complication of enteral feeding. Many critically ill patients are particularly at risk for aspiration. Few studies have rigorously compared various access devices. Risk factors for aspiration and studies examining aspiration associated with enteral feeding devices are reviewed. We recommend a surgical jejunostomy for all patients at high risk for aspiration who require more than 3 weeks of enteral nutrition support.

scholarly journals Copeptin and Arginine Vasopressin Concentrations in Critically Ill Patients

2006 ◽  
Vol 91 (11) ◽  
pp. 4381-4386 ◽  
Author(s):  
Stefan Jochberger ◽  
Nils G. Morgenthaler ◽  
Viktoria D. Mayr ◽  
Günter Luckner ◽  
Volker Wenzel ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Healthy Volunteers ◽  
Critically Ill ◽  
Arginine Vasopressin ◽  
Critically Ill Patients ◽  
Plasma Concentrations ◽  
University Teaching ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Icu Patients

Abstract Context: Determination of arginine vasopressin (AVP) concentrations may be helpful to guide therapy in critically ill patients. A new assay analyzing copeptin, a stable peptide derived from the AVP precursor, has been introduced. Objective: Our objective was to determine plasma copeptin concentrations. Design: We conducted a post hoc analysis of plasma samples and data from a prospective study. Setting: The setting was a 12-bed general and surgical intensive care unit (ICU) in a tertiary university teaching hospital. Patients: Our subjects were 70 healthy volunteers and 157 ICU patients with sepsis, with systemic inflammatory response syndrome (SIRS), and after cardiac surgery. Interventions: There were no interventions. Main Outcome Measures: Copeptin plasma concentrations, demographic data, AVP plasma concentrations, and a multiple organ dysfunction syndrome score were documented 24 h after ICU admission. Results: AVP (P < 0.001) and copeptin (P < 0.001) concentrations were significantly higher in ICU patients than in controls. Patients after cardiac surgery had higher AVP (P = 0.003) and copeptin (P = 0.003) concentrations than patients with sepsis or SIRS. Independent of critical illness, copeptin and AVP correlated highly significantly with each other. Critically ill patients with sepsis and SIRS exhibited a significantly higher ratio of copeptin/AVP plasma concentrations than patients after cardiac surgery (P = 0.012). The American Society of Anesthesiologists’ classification (P = 0.046) and C-reactive protein concentrations (P = 0.006) were significantly correlated with the copeptin/AVP ratio. Conclusions: Plasma concentrations of copeptin and AVP in healthy volunteers and critically ill patients correlate significantly with each other. The ratio of copeptin/AVP plasma concentrations is increased in patients with sepsis and SIRS, suggesting that copeptin may overestimate AVP plasma concentrations in these patients.

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