Migration of Feeding Tubes Assessed by Using an Electromagnetic Device: A Cohort Study

2020 ◽  
Vol 29 (6) ◽  
pp. 439-447
Author(s):  
Annette M. Bourgault ◽  
Jan Powers ◽  
Lillian Aguirre ◽  
Robert Hines
Keyword(s):  
Cohort Study ◽  
Repeated Measures ◽  
Feeding Tube ◽  
Feeding Tubes ◽  
Repeated Measures Analysis ◽  
Tube Migration ◽  
Spontaneous Migration ◽  
Clinically Significant ◽  
Critically Ill Adults ◽  
Ill Adults

Background Bedside methods to verify placement of a feeding tube are not accurate for detecting placement within the gastrointestinal tract, increasing risk of pulmonary aspiration. Current guidelines recommend verifying placement every 4 hours, yet the rationale for this recommendation is unknown. Objective To assess spontaneous migration of small-bore feeding tubes in critically ill adults. Methods A prospective, repeated-measures cohort study was performed in 2 intensive care units. An electromagnetic placement device was used to assess distal feeding tube location every 24 hours for 7 days. Tube migration between zones—esophageal, gastric, and postpyloric— was considered clinically significant. Results Feeding tubes were analyzed in 20 patients. Interrater agreement was substantial for round 2 of a blinded analysis of insertion tracings (g = 0.78); 100% agreement was achieved after unblinding. Among 62 outcomes (migration assessments), 4 feeding tubes migrated 8 times (3 forward and 5 retrograde). All migrations occurred in the postpyloric zone and none were clinically significant. Within 24 hours of insertion, 50% of feeding tubes had migrated forward. Repeated-measures analysis showed a greater likelihood of migration in patients with an endotracheal tube (relative risk, 3.46 [95% CI, 1.14-10.53]; P = .03). Conclusions No tubes migrated retrograde into the stomach or esophagus, challenging the practice of verifying placement every 4 hours. Verification every 24 hours may be adequate if migration is not suspected. Also, lack of visible anatomical structures on insertion tracings from an electromagnetic placement device make subtle changes in postpyloric placement difficult to identify accurately.

scholarly journals Co-infection in critically ill patients with COVID-19: An observational cohort study from England

2020 ◽  
Author(s):  
Vadsala Baskaran ◽  
Hannah Lawrence ◽  
Louise Lansbury ◽  
Karmel Webb ◽  
Shahideh Safavi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Critically Ill ◽  
High Rate ◽  
Gram Negative ◽  
Icu Stay ◽  
Observational Cohort ◽  
Clinically Significant ◽  
Critically Ill Adults ◽  
Hospital Acquired ◽  
Ill Adults

AbstractObjectiveTo describe the incidence and nature of co-infection in critically ill adults with COVID-19 infection in England.MethodsA retrospective cohort study of adults with COVID-19 admitted to seven intensive care units (ICUs) in England up to 18 May 2020, was performed. Patients with completed ICU stays were included. The proportion and type of organisms were determined at <48 and >48 hours following hospital admission, corresponding to community and hospital-acquired co-infections.ResultsOf 254 patients studied (median age 59 years (IQR 49-69); 64.6% male), 139 clinically significant organisms were identified from 83(32.7%) patients. Bacterial co-infections were identified within 48 hours of admission in 14(5.5%) patients; the commonest pathogens were Staphylococcus aureus (four patients) and Streptococcus pneumoniae (two patients). The proportion of pathogens detected increased with duration of ICU stay, consisting largely of Gram-negative bacteria, particularly Klebsiella pneumoniae and Escherichia coli. The co-infection rate >48 hours after admission was 27/1000 person-days (95% CI 21.3-34.1). Patients with co-infections were more likely to die in ICU (crude OR 1.78,95% CI 1.03-3.08, p=0.04) compared to those without co-infections.ConclusionWe found limited evidence for community-acquired bacterial co-infection in hospitalised adults with COVID-19, but a high rate of Gram-negative infection acquired during ICU stay.

Tracheotomy in comparison with tracheopathia for prolonged intubation of the lungs in surgical patients

2020 ◽  
pp. 79-86
Author(s):  
A. A. Teuvov ◽  
A. M. Baziev ◽  
Z. N. Lovpache ◽  
T. G. Tlupova ◽  
A. I. Sardiyanov
Keyword(s):  
Critically Ill ◽  
Randomized Clinical Trials ◽  
Patient Survival ◽  
Surgical Patients ◽  
Surgical Wound ◽  
Prolonged Intubation ◽  
Clinically Significant ◽  
Critically Ill Adults ◽  
Ill Adults

A comparative analysis of the MEDLINE, EMBASE, CINAHL and Cochrane Registry databases was carried out to identify the advantages of puncture-dilatation tracheostomy methods over standard tracheotomy in critically ill patients. In addition, bibliographies and selected conference proceedings were reviewed; included randomized clinical trials comparing puncture-dilatation techniques with standard tracheotomy in critically ill adults, which reported clinically significant outcomes. The extracted data are focused on the criteria for the validity of the studies and the results relevant to practice. Puncture methods are less traumatic and can reduce the likelihood of infection of the surgical wound. Compared to the traditional method, a puncture tracheostomy can be applied in just 2 minutes,which can play a significant role in the prognosis of patient survival. The role of the experience of the operators performing the procedures has a significant impact on the results, which cannot be formally and quantitatively assessed in our analysis.

Hemodynamic Effects of Ketamine Compared With Propofol or Dexmedetomidine as Continuous ICU Sedation

2021 ◽  
pp. 106002802110510
Author(s):  
Evan Atchley ◽  
Eljim Tesoro ◽  
Robert Meyer ◽  
Alexia Bauer ◽  
Mark Pulver ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Clinically Significant ◽  
Critically Ill Adults ◽  
Icu Sedation ◽  
Ill Adults ◽  
Positive Effect

Background Ketamine has seen increased use for sedation in the intensive care unit. In contrast to propofol or dexmedetomidine, ketamine may provide a positive effect on hemodynamics. Objective The objective of this study was to compare the development of clinically significant hypotension or bradycardia (ie, negative hemodynamic event) between critically ill adults receiving sedation with ketamine and either propofol or dexmedetomidine. Methods This was a retrospective cohort study of adults admitted to an intensive care unit at an academic medical center between January 2016 and January 2021. Results Patients in the ketamine group (n = 78) had significantly less clinically significant hypotension or bradycardia compared with those receiving propofol or dexmedetomidine (n = 156) (34.6% vs 63.5%; P < 0.001). Patients receiving ketamine also experienced smaller degree of hypotension observed by percent decrease in mean arterial pressure (25.3% [17.4] vs 33.8% [14.5]; P < 0.001) and absolute reduction in systolic blood pressure (26.5 [23.8] vs 42.0 [37.8] mm Hg; P < 0.001) and bradycardia (15.5 [24.3] vs 32.0 [23.0] reduction in beats per minute; P < 0.001). In multivariate logistic regression modeling, receipt of propofol or dexmedetomidine was the only independent predictor of a negative hemodynamic event (odds ratio [OR]: 3.3, 95% confidence interval [CI], 1.7 to 6.1; P < 0.001). Conclusion and Relevance Ketamine was associated with less clinically relevant hypotension or bradycardia when compared with propofol or dexmedetomidine, in addition to a smaller absolute decrease in hemodynamic parameters. The clinical significance of these findings requires further investigation.

Predictors of pressure injury development in critically ill adults: A retrospective cohort study

2021 ◽  
Vol 62 ◽  
pp. 102924 ◽  
Author(s):  
Jennifer J. Sala ◽  
Anoop Mayampurath ◽  
Susan Solmos ◽  
Susan C. Vonderheid ◽  
Marianne Banas ◽  
...  
Keyword(s):  
Cohort Study ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Pressure Injury ◽  
Critically Ill Adults ◽  
Ill Adults

scholarly journals Severe Imported Falciparum Malaria: A Cohort Study in 400 Critically Ill Adults

PLoS ONE ◽  
2010 ◽  
Vol 5 (10) ◽  
pp. e13236 ◽  
Author(s):  
Fabrice Bruneel ◽  
Florence Tubach ◽  
Philippe Corne ◽  
Bruno Megarbane ◽  
Jean-Paul Mira ◽  
...  
Keyword(s):  
Cohort Study ◽  
Falciparum Malaria ◽  
Critically Ill ◽  
Critically Ill Adults ◽  
Ill Adults

scholarly journals Comparison of Growth Velocity Among School Age Children With Different Body Mass Index From Childhood Into Early Adolescence in Hualien County, Taiwan: A Retrospective Cohort Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Yu-Chao Hsiao ◽  
Jen-Hung Wang ◽  
Chia-Hsiang Chu ◽  
Yu-Hsun Chang ◽  
Jui-Shia Chen ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Cohort Study ◽  
Weight Gain ◽  
Risk Analysis ◽  
Growth Velocity ◽  
Retrospective Cohort Study ◽  
Repeated Measures ◽  
Retrospective Cohort ◽  
Linear Growth ◽  
Repeated Measures Analysis

Objective: This study aimed to investigate the contribution of high body mass index (BMI) to growth velocity among school-aged children who remained in the same BMI categories for a 6-year period.Methods: This retrospective cohort study included children who enrolled in the school year 2009 and remained in the same BMI categories during their 1st, 4th, and 7th grades (6–7, 9–10, 12–13 years of age). Annual linear growth velocity and weight gain were calculated and compared between sexes, BMI groups, and different times. Risk analysis and repeated measures analysis of variance were performed to identify the impact of BMI on growth velocity.Results: Of the 1,637 subjects, 53.0% were male, and 2.5% and 10.9% belonged to BMI groups of overweight and obese, respectively. In students between 6 and 13 years of age, obesity was associated with higher annual weight gain and height gain. Risk analysis showed that obese subjects had higher linear growth velocity than normal BMI groups of both sexes between 6 and 9 years of age. Unexpectedly, overweight and obese girls between 9 and 13 years of age had less linear growth velocity than underweight girls at the same interval. Repeated measures analysis of variance in both sexes showed a significant statistical association between BMI and different times of growth. However, the effect was less in girls between 9 and 13 years of age.Conclusion: Puberty may dominate over BMI as the main contributor to high growth velocity in girls with underweight BMI emerging into pubertal age.

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