Vomiting and large nasogastric aspirates in the critically ill

2016 ◽  
Author(s):  
Tong J. Gan ◽  
John T. Lemm
Keyword(s):  
Enteral Nutrition ◽  
Critically Ill ◽  
Nausea And Vomiting ◽  
Side Effect Profile ◽  
Serotonin Antagonists ◽  
Common Occurrence ◽  
First Line ◽  
Nutrition Management ◽  
Wide Range ◽  
Favourable Side Effect Profile

A wide range of conditions can cause nausea and vomiting, making it a common occurrence in the critically ill. A deeper understanding of the pathophysiology of vomiting has led to the emergence of effective anti-emetics, each targeting a specific neurotransmitter in the emetic pathway. Serotonin antagonists are the first line anti-emetic of choice for most cases of nausea and vomiting due to their efficacy and favourable side effect profile. Large nasogastric aspirates are commonly encountered in the critically ill, and must be managed aggressively in order to prevent delays in enteral nutrition. Management of large gastric aspirates involves gastric drainage, prokinetic agents, and if necessary, post-pyloric feeding.

scholarly journals Practice Guidelines for Enteral Nutrition Management in Dysglycemic Critically Ill Patients: A Relook for Indian Scenario

2019 ◽  
Vol 23 (12) ◽  
pp. 594-603
Author(s):  
Ambrish Mithal ◽  
Jeetendra Sharma ◽  
Atul Kulkarni ◽  
MN Sivakumar ◽  
Yatin Mehta ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Critically Ill ◽  
Practice Guidelines ◽  
Critically Ill Patients ◽  
Nutrition Management ◽  
Indian Scenario

Experiences of job demand and control: A study of first line managers in for-profit psychiatric and addiction care

Work ◽  
2021 ◽  
pp. 1-9
Author(s):  
Linda Widar ◽  
Erika Wall ◽  
Sven Svensson
Keyword(s):  
First Line ◽  
Line Managers ◽  
For Profit ◽  
Job Demand ◽  
Organizational Position ◽  
Wide Range ◽  
Line Manager ◽  
Addiction Care ◽  
And Control ◽  
Demand Control

BACKGROUND: The complex position of a first line manager is characterized by heavy workload and contradictory demands. Little is known about how first line managers experience demand and control in their work. OBJECTIVES: The aim of this study was to explore experiences of demand and control among first line managers within psychiatric and addiction care. METHOD: In the present study, interviews with ten managers in for-profit psychiatric and addiction care in Sweden were analyzed with a phenomenographic approach. RESULTS: The managers experiences of demand and control implied varied and extensive responsibilities for a wide range of professions; regulation by organizational, economic, and political frameworks; creating balance in their work; and handling the emergence and consequences of acute crisis. These experiences of demand and control involved high and contradictory demands together with coexisting high and low levels of control. Many of their work characteristics could be described in terms of both demand and control. CONSLUSION: The first line managers experiences of demand and control are more complex than implied by the job demand control theory. Our results suggest that the organizational position and branch should be considered when identifying health hazards in the work environment of first line managers.

Pharmacological Management of Seizures and Status Epilepticus in Critically Ill Patients

2010 ◽  
Vol 23 (5) ◽  
pp. 441-454 ◽  
Author(s):  
Eljim P. Tesoro ◽  
Gretchen M. Brophy
Keyword(s):  
Status Epilepticus ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Neurological Disease ◽  
Medical Emergency ◽  
Significant Morbidity ◽  
First Line ◽  
Short Term ◽  
Pharmacological Management ◽  
First Line Treatment

Seizures are serious complications seen in critically ill patients and can lead to significant morbidity and mortality if the cause is not identified and treated quickly. Uncontrolled seizures can lead to status epilepticus (SE), which is considered a medical emergency. The first-line treatment of seizures is an intravenous (IV) benzodiazepine followed by anticonvulsant therapy. Refractory SE can evolve into a nonconvulsive state requiring IV anesthetics or induction of pharmacological coma. To prevent seizures and further complications in critically ill patients with acute neurological disease or injury, short-term seizure prophylaxis should be considered in certain patients.

scholarly journals The frequency, risk factors, and complications of gastrointestinal dysfunction during enteral nutrition in critically ill patients

2018 ◽  
Vol Volume 14 ◽  
pp. 385-391 ◽  
Author(s):  
Ayse Gulsah Atasever ◽  
Perihan Ergin ozcan ◽  
Kamber Kasali ◽  
Taner Abdullah ◽  
Gunseli Orhun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Gastrointestinal Dysfunction

scholarly journals Risks in Management of Enteral Nutrition in Intensive Care Units: A Literature Review and Narrative Synthesis

Nutrients ◽  
2020 ◽  
Vol 13 (1) ◽  
pp. 82
Author(s):  
Magdalena Hoffmann ◽  
Christine Maria Schwarz ◽  
Stefan Fürst ◽  
Christina Starchl ◽  
Elisabeth Lobmeyr ◽  
...  
Keyword(s):  
Patient Safety ◽  
Intensive Care ◽  
Clinical Practice ◽  
Literature Review ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Rapid Review ◽  
Narrative Synthesis ◽  
Safety Issues

Critically ill patients in the intensive care unit (ICU) have a high risk of developing malnutrition, and this is associated with poorer clinical outcomes. In clinical practice, nutrition, including enteral nutrition (EN), is often not prioritized. Resulting from this, risks and safety issues for patients and healthcare professionals can emerge. The aim of this literature review, inspired by the Rapid Review Guidebook by Dobbins, 2017, was to identify risks and safety issues for patient safety in the management of EN in critically ill patients in the ICU. Three databases were used to identify studies between 2009 and 2020. We assessed 3495 studies for eligibility and included 62 in our narrative synthesis. Several risks and problems were identified: No use of clinical assessment or screening nutrition assessment, inadequate tube management, missing energy target, missing a nutritionist, bad hygiene and handling, wrong time management and speed, nutritional interruptions, wrong body position, gastrointestinal complication and infections, missing or not using guidelines, understaffing, and lack of education. Raising awareness of these risks is a central aspect in patient safety in ICU. Clinical experts can use a checklist with 12 identified top risks and the recommendations drawn up to carry out their own risk analysis in clinical practice.

Implementing Volume-Based Feeding to Optimize Delivery of Enteral Nutrition

2021 ◽  
Vol 41 (2) ◽  
pp. 16-26
Author(s):  
Angela Bonomo ◽  
Diane Lynn Blume ◽  
Katie Davis ◽  
Hee Jun Kim
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Educational Approach ◽  
Lecture Demonstration

Background At least 80% of ordered enteral nutrition should be delivered to improve outcomes in critical care patients. However, these patients typically receive 60% to 70% of ordered enteral nutrition volume. In a practice review within a 28-bed medical-surgical adult intensive care unit, patients received a median of 67.5% of ordered enteral nutrition with standard rate-based feeding. Volume-based feeding is recommended to deliver adequate enteral nutrition to critically ill patients. Objective To use a quality improvement project to increase the volume of enteral nutrition delivered in the medical-surgical intensive care unit. Methods Percentages of target volume achieved were monitored in 73 patients. Comparisons between the rate-based and volume-based feeding groups used nonparametric quality of medians test or the χ2 test. A customized volume-based feeding protocol and order set were created according to published protocols and then implemented. Standardized education included lecture, demonstration, written material, and active personal involvement, followed by a scenario-based test to apply learning. Results Immediately after implementation of this practice change, delivered enteral nutrition volume increased, resulting in a median delivery of 99.8% of ordered volume (P = .003). Delivery of a mean of 98% ordered volume was sustained over the 15 months following implementation. Conclusions Implementation of volume-based feeding optimized enteral nutrition delivery to critically ill patients in this medical-surgical intensive care unit. This success can be attributed to a comprehensive, individualized, and proactive process design and educational approach. The process can be adapted to quality improvement initiatives with other patient populations and units.

Association Between Anticholinergic Drug Burden and Adequacy of Enteral Nutrition in Critically Ill, Mechanically Ventilated Pediatric Patients

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Enid E. Martinez ◽  
Hongxing Dang ◽  
Jennifer Franks ◽  
Charles G. Callif ◽  
Robert C. Tasker ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Critically Ill ◽  
Pediatric Patients ◽  
Anticholinergic Drug ◽  
Mechanically Ventilated
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