Early postoperative gastric enteral nutrition improve gastric emptying after cardiac surgery

Open Medicine ◽  
2006 ◽  
Vol 1 (3) ◽  
pp. 284-291
Author(s):  
Alan Šustić ◽  
Marko Zelić ◽  
Igor Medved ◽  
Jadranko Sokolić
Keyword(s):  
Cardiac Surgery ◽  
Gastric Emptying ◽  
Enteral Nutrition ◽  
Enteral Feeding ◽  
Nasogastric Tube ◽  
Randomized Study ◽  
Control Group ◽  
Cabg Surgery ◽  
Paracetamol Absorption ◽  
Enteral Formula

AbstractPostoperative intragastric enteral feeding in cardiac surgery patients is frequently complicated by delayed gastric emptying. The aim of the study was to evaluate how early postoperative gastric enteral nutrition affects the gastric emptying in coronary artery by-pass graft (CABG) surgery patients.In the prospective, randomized study 40 patients treated at intensive care unit after CABG surgery were studied. Patients were divided in two groups: enteral feeding group E (20 patients: age 59±8 yr.; male 70%) and control group C (20 patients: age 58±10 yr.; male 80%), respectively. Paracetamol absorption test was used to evaluate gastric emptying. In the group E postoperative gastric supply of enteral formula begun 18 hours after surgery and after 6 hours the supply was stopped and paracetamol solution was administrated by nasogastric tube. The patients in group C for.rst 24 hours received only crystalloid solutions intravenously and paracetamol solution by nasogastric tube. Blood samples were obtained at 0 (t0), 15 (t+15), 30 (t+30), 60 (t+60) and 120 (t+120) min after administration of paracetamol.The values of plasma paracetamol concentration (PPC) at 15 and 120 min were significantly higher in group E vs. group C: (t+15) 3.3±2.5 vs. 1.7±1.9 and (t+120) 5.2−2.8 vs. 3.3±1.6 (p <0.05). The PPC values at 30 and 60 min were higher, but not signi.cantly, in group E vs. group C: (t+30) 3.7±2.0 vs. 2.9±2.7 and (t+60) 5.1±3.2 vs. 3.9±3.5 (p = NS). The area under the PPC curve was 429 ± 309 in the E group vs. 293 ± 204 in the group C (p < 0.05).In conclusion an early postoperative gastric administration of nutritients after CABG surgery stimulates the gastric emptying.

Nutrition accesses among patients receiving enteral treatment in the home environment

2017 ◽  
Vol 89 (5) ◽  
pp. 6-11 ◽  
Author(s):  
Janusz Sznajder ◽  
Marta Ślefarska-Wasilewska ◽  
Piotr Wójcik
Keyword(s):  
Enteral Nutrition ◽  
Digestive Tract ◽  
Home Environment ◽  
Enteral Feeding ◽  
Nasogastric Tube ◽  
Gold Standard

Enteral feeding in the home environment is connected with creating access to digestive tract, and thanks to that, this kind of treatment is possible. The gold standard in enteral nutrition is PEG, other types of access are: nasogastric tube, gastronomy and jejunostomy. In the article 851 patients who were treated nutritionally in the home environment, in the nutrition clinic, Nutrimed Górny Śląsk, were analyzed. It was described how, in practice, the schedule of nutrition access looks like in the nutrition clinic at a time of qualifying patients to the treatment (PEG 47,35%, gastronomy 18,91%, nasogastric tube 17,39%,jejunostomy 16,33%) and how it changes among patients treated in the nutrition clinic during specific period of time – to the treatment there were qualified patients with at least three-month period of therapy ( second evaluation: PEG 37,01%, gastrostomy 31,13%, nasogastric tube 16,98%, jejunostomy 15,86%). The structure of changes was described, also the routine and the place in what exchanging or changing nutrition access was analyzed. Conclusions: The biggest changes in quantity, among all groups of ill people concerned patients with PEG and gastronomy. In most cases the intervention connected with exchanging access to the digestive tract could be implemented at patient’s home.

Improvement of Nutritional Intake in Intensive Care Unit Patients via a Nurse-Led Enteral Nutrition Feeding Protocol

2018 ◽  
Vol 38 (3) ◽  
pp. 38-44 ◽  
Author(s):  
Ira Orinovsky ◽  
Ela Raizman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Enteral Nutrition ◽  
Enteral Feeding ◽  
Intervention Group ◽  
Nutritional Intake ◽  
Control Group ◽  
Clinical Value ◽  
Feeding Group ◽  
Feeding Protocol

Background Enteral nutrition in intensive care unit patients has important prognostic clinical value. Feeding protocols are recommended by clinical practice guidelines as a key strategy to maximize the benefits and minimize the risks of enteral feedings. Objective To examine whether enteral nutrition in critically ill patients could be improved by implementation of a nurse-led evidence-based feeding protocol. Methods An interprofessional group of intensive care unit nurses, physicians, and a clinical dietitian designed a protocol to address and correct the shortcomings of enteral feeding. Data on feeding and clinical outcomes were collected retrospectively for patients for 12 months before (control group) and then for 12 months after (interventional group) implementation of the protocol. Results Enteral feeding was started significantly earlier (P = .007) after admission to the intensive care unit in the intervention group (52.3 hours; SD, 42.6) than in the control group (70.3 hours; SD, 65.2). Use of the protocol resulted in a significant increase in nutritional intake; 90% of patients in the intervention group but only 34% in the traditional feeding group achieved their caloric target within 96 hours after admission (P &lt; .001). After implementation of the protocol, cessation of feeding due to intolerance was significantly less (P = .03) in the intervention group (6%) than in the traditional feeding group (14 %), and no adverse events were detected. Conclusions Adherence to standardized guidelines with a written protocol for an early start and timely escalation of enteral feeding can improve nutritional intake among intensive care unit patients.

scholarly journals Pupillometry pain index decreases intraoperative sufentanyl administration in cardiac surgery: a prospective randomized study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Vivien Berthoud ◽  
Maxime Nguyen ◽  
Anouck Appriou ◽  
Omar Ellouze ◽  
Mohamed Radhouani ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cardiac Surgery ◽  
Primary Outcome ◽  
Randomized Study ◽  
Intervention Group ◽  
Prospective Randomized Study ◽  
Control Group ◽  
Standard Group ◽  
Postoperative Course ◽  
The Impact

AbstractPupillometry has proven effective for the monitoring of intraoperative analgesia in non-cardiac surgery. We performed a prospective randomized study to evaluate the impact of an analgesia-guided pupillometry algorithm on the consumption of sufentanyl during cardiac surgery. Fifty patients were included prior to surgery. General anesthesia was standardized with propofol and target-controlled infusions of sufentanyl. The standard group consisted of sufentanyl target infusion left to the discretion of the anesthesiologist. The intervention group consisted of sufentanyl target infusion based on the pupillary pain index. The primary outcome was the total intraoperative sufentanyl dose. The total dose of sufentanyl was lower in the intervention group than in the control group and (55.8 µg [39.7–95.2] vs 83.9 µg [64.1–107.0], p = 0.04). During the postoperative course, the cumulative doses of morphine (mg) were not significantly different between groups (23 mg [15–53] vs 24 mg [17–46]; p = 0.95). We found no significant differences in chronic pain at 3 months between the 2 groups (0 (0%) vs 2 (9.5%) p = 0.49). Overall, the algorithm based on the pupillometry pain index decreased the dose of sufentanyl infused during cardiac surgery.Clinical trial number: NCT03864016.

scholarly journals Effects of a Synbiotic Formula on Functional Bowel Disorders and Gut Microbiota Profile during Long-Term Home Enteral Nutrition (LTHEN): A Pilot Study

Nutrients ◽  
2020 ◽  
Vol 13 (1) ◽  
pp. 87
Author(s):  
Valentina D’Onofrio ◽  
Federica Del Chierico ◽  
Paola Belci ◽  
Pamela Vernocchi ◽  
Andrea Quagliariello ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Gut Microbiota ◽  
Intervention Group ◽  
Short Chain Fatty Acids ◽  
Stool Consistency ◽  
Control Group ◽  
Open Label ◽  
Intestinal Functions ◽  
Enteral Formula

Long-term enteral nutrition (LTEN) can induce gut microbiota (GM) dysbiosis and gastrointestinal related symptoms, such as constipation or diarrhoea. To date, the treatment of constipation is based on the use of laxatives and prebiotics. Only recently have probiotics and synbiotics been considered, the latter modulating the GM and regulating intestinal functions. This randomized open-label intervention study evaluated the effects of synbiotic treatment on the GM profile, its functional activity and on intestinal functions in long-term home EN (LTHEN) patients. Twenty LTHEN patients were recruited to take enteral formula plus one sachet/day of synbiotic (intervention group, IG) or enteral formula (control group, CG) for four months and evaluated for constipation, stool consistency, and GM and metabolite profiles. In IG patients, statistically significant reduction of constipation and increase of stool consistency were observed after four months (T1), compared to CG subjects. GM ecology analyses revealed a decrease in the microbial diversity of both IC and CG groups. Biodiversity increased at T1 for 5/11 IG patients and Methanobrevibacter was identified as the biomarker correlated to the richness increase. Moreover, the increase of short chain fatty acids and the reduction of harmful molecules have been correlated to synbiotic administration. Synbiotics improve constipation symptoms and influences Methanobrevibacter growth in LTHEN patients.

scholarly journals The Effect of Low Doses of Epsilon-Aminocaproic Acid on Blood Loss Following Cardiac Surgery under Cardiopulmonary Bypass

2019 ◽  
pp. 70-76
Author(s):  
D. V. Osipenko ◽  
A. A. Skorokhodov ◽  
A. A. Silanov
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Loss ◽  
Randomized Study ◽  
Aminocaproic Acid ◽  
Control Group ◽  
Low Doses ◽  
Thoracic Drainage ◽  
Group 2 ◽  
Epsilon Aminocaproic Acid

Objective: to study the effectiveness of the application of low doses of epsilon-aminocaproic acid (EACA) (8-12 g) during cardiac operations under cardiopulmonary bypass (CPB) with the assessment of the effect on blood loss, number of transfusions, complications, and thromboelastometry parameters. Material and methods. The prospective, randomized study included 113 patients undergoing routine cardiac surgery under cardiopulmonary bypass. Two groups were formed: group 1 (n = 51) - an EACA bolus of 75 mg/kg was administered intravenously with titration of 30 mg/kg/h during CPB; group 2 (n = 62) was the control group. Conclusion. The introduction of low doses of EACA (10.2 (8.9; 11.4) g) reduces the thoracic-drainage volume by 30 %, reduces the frequency of donor blood transfusions by 38 % within 36-48 hours after the surgery without increasing the number of complications.

scholarly journals Restrictive Transfusion Strategy after Cardiac Surgery

2021 ◽  
Vol 134 (3) ◽  
pp. 370-380 ◽  
Author(s):  
Norddine Zeroual ◽  
Cinderella Blin ◽  
Marine Saour ◽  
Hélène David ◽  
Safa Aouinti ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Controlled Trial ◽  
Randomized Study ◽  
Study Groups ◽  
University Hospital ◽  
Control Group ◽  
Transfusion Strategy ◽  
Restrictive Transfusion ◽  
Icu Stay ◽  
Restrictive Transfusion Strategy

Background Recent guidelines on transfusion in cardiac surgery suggest that hemoglobin might not be the only criterion to trigger transfusion. Central venous oxygen saturation (Svo2), which is related to the balance between tissue oxygen delivery and consumption, may help the decision process of transfusion. We designed a randomized study to test whether central Svo2–guided transfusion could reduce transfusion incidence after cardiac surgery. Methods This single center, single-blinded, randomized controlled trial was conducted on adult patients after cardiac surgery in the intensive care unit (ICU) of a tertiary university hospital. Patients were screened preoperatively and were assigned randomly to two study groups (control or Svo2) if they developed anemia (hemoglobin less than 9 g/dl), without active bleeding, during their ICU stay. Patients were transfused at each anemia episode during their ICU stay except the Svo2 patients who were transfused only if the pretransfusion central Svo2 was less than or equal to 65%. The primary outcome was the proportion of patients transfused in the ICU. The main secondary endpoints were (1) number of erythrocyte units transfused in the ICU and at study discharge, and (2) the proportion of patients transfused at study discharge. Results Among 484 screened patients, 100 were randomized, with 50 in each group. All control patients were transfused in the ICU with a total of 94 transfused erythrocyte units. In the Svo2 group, 34 (68%) patients were transfused (odds ratio, 0.031 [95% CI, 0 to 0.153]; P &lt; 0.001 vs. controls), with a total of 65 erythrocyte units. At study discharge, eight patients of the Svo2 group remained nontransfused and the cumulative count of erythrocyte units was 96 in the Svo2 group and 126 in the control group. Conclusions A restrictive transfusion strategy adjusted with central Svo2 may allow a significant reduction in the incidence of transfusion. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals The Placement of Post-pyloric Feeding Tubes Using DRX-Revolution Mobile X-Ray System in an ICU. A Case Series

2016 ◽  
Vol 2 (3) ◽  
pp. 131-134
Author(s):  
Leonid Koyfman ◽  
Andrei Schwartz ◽  
Yair Benjamin ◽  
Alexander Smolikov ◽  
Moti Klein ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Critically Ill ◽  
Enteral Feeding ◽  
Nasogastric Tube ◽  
Critically Ill Patients ◽  
Case Series ◽  
Feeding Tube ◽  
Nasogastric Feeding ◽  
X Ray ◽  
Feeding Tubes

Abstract Enteral nutrition is crucial for ensuring that critically ill patients have a proper intake of food, water, and medicine. Methods to ensure this requirement should be initiated as early as possible. The use of PPF has several advantages compared to the use of a nasogastric feeding tube. In the present paper, the cases of three critically ill patients with a nonfunctional gastrointestinal system on admission to ICU, are detailed. Enteral feeding through a nasogastric tube by prokinetic agent therapy had been unsuccessful. The bedside placement of a post-pyloric feeding tube by the DRX-Revolution X-ray system is described.

Clinical efficacy of osteopathic correction in the complex treatment of patients with unoperated open-angle glaucoma

2020 ◽  
pp. 97-105
Author(s):  
E. N. Simakova ◽  
O. V. Stenkova
Keyword(s):  
Intraocular Pressure ◽  
Drug Therapy ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Randomized Study ◽  
Main Group ◽  
Control Group ◽  
Open Angle ◽  
Complex Treatment ◽  
Hypotensive Drug

Introduction. Glaucoma is one of the most significant eye diseases. It is often diagnosed, not always amenable to therapy, and can lead to a complete loss of visual functions. In recent years, the method of osteopathic correction has become widespread as one of the effective methods of treatment and rehabilitation of patients with pathologies of various body systems. In the pathogenesis of glaucoma, it is customary to distinguish a dystrophic concept, which considers primary open-angle glaucoma as a result of dystrophic changes in the connective tissue, as well as in the endothelial lining of the trabeculae and Schlemm′s canal, especially destructive changes in mitochondria and the alteration of their functional activity. A vascular concept is also distinguished. According to this concept, the central link in the pathogenesis of glaucoma is circulatory disorder in the ciliary vessels, ocular artery, and major vessels of the head and neck, it can be assumed that osteopathic correction in the treatment of patients with open-angle glaucoma will be pathogenetically substantiated and will have a positive effect on intraocular pressure and trophicity of the optic nerve. The goal of research — to study the influence of in osteopathic correction on the nature of unoperated glaucoma (stage IIA) and to substantiate the possibility of using osteopathic correction in the complex treatment of patients with this pathology.Materials and methods. A prospective controlled randomized study was conducted at 52 city polyclinics, branch 3, Moscow, from January 2018 to January 2019. 40 patients (70 eyes) aged 50 to 75 years with primary open-angle glaucoma IIA stage were examined. At this stage of the disease, patients most often seek medical care and the issue of conservative management is primarily considered. All patients were divided into two groups of 20 people: the main group and the control group. The treatment in the main group included hypotensive drug therapy and osteopathic correction. Patients of the control group received only drug therapy. All patients underwent ophthalmic (visometry, tonometry, perimetry) and osteopathic examination twice: before the treatment and after 3 months.Results. For patients with primary open-angle IIA non-operated glaucoma, regional (most often regions of the head, neck, dura mater) and local (abdominal diaphragm, iliac bones, hip and knee joints) somatic dysfunctions were the most typical. In the main group a statistically significant decrease in the frequency and severity of dysfunctions at all levels was stated. Also, in patients receiving osteopathic correction, a significant decrease in the level of intraocular pressure and perimetric indices was noted. In patients of the control group, no reliable changes in these indicators were obtained.Conclusion. The results obtained indicate that osteopathic correction is clinically effective in the complex treatment of patients with primary open-angle II A glaucoma.

Pretreatment with Methylprednisolone Improves Myocardial Protection during On-Pump Coronary Artery Bypass Surgery

2015 ◽  
Vol 18 (4) ◽  
pp. 171 ◽  
Author(s):  
Tolga Demir ◽  
Mehmet Umit Ergenoglu ◽  
Hale Bolgi Demir ◽  
Nursen Tanrikulu ◽  
Mazlum Sahin ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Myocardial Protection ◽  
Troponin T ◽  
Artery Bypass ◽  
Control Group ◽  
Study Group ◽  
Cabg Surgery ◽  
Anti Inflammatory ◽  
Pump Coronary Artery Bypass

<strong>Background</strong>: This study was undertaken to determine whether methylprednisolone could improve myocardial protection by altering the cytokine profile toward an anti-inflammatory course in patients undergoing elective coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB).<br /><strong>Methods</strong>: Forty patients who were scheduled for elective CABG surgery were randomized into two groups: the study group (n = 20), who received 1 g of methylprednisolone intravenously before CPB, and the control group (n = 20), who underwent a standard CABG surgery without any additional medication. Blood samples were withdrawn prior to surgery (T1) and then 4 hours (T2), 24 hours (T3), and 36 hours (T4) after CPB. Plasma levels of interleukin (IL)-6, IL-10, creatine kinase isoenzyme MB (CK-MB), cardiac troponin-t (cTnT), and blood glucose as well as neutrophil counts were measured at each sampling time. <br /><strong>Results</strong>: A comparison of patients between both groups revealed significantly high levels of IL-6 in the control group at T2, T3, and T4 with respect to T1 (T2: P &lt; .001; T3: <br />P &lt; .001; T4: P &lt; .001). IL-10 levels were significantly higher in the study group at T2 compared with the control group <br />(P = .007). CK-MB levels were significantly lower in the study group than in the control group at T4 (P = .001). The increase of cTnT was higher in the control group at T3 and T4 compared with the study group (T3: P = .002; T4: P = .001).<br /><strong>Conclusions</strong>: This study demonstrates that methylprednisolone is effective for ensuring better myocardial protection during cardiac surgery by suppressing the inflammatory response via decreasing the levels of IL-6 and by increasing anti-inflammatory activity through IL-10.<br /><br />

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