Purpose of review: This article reviews the thoracic complications from malpositioned blindly inserted nasogastric feeding tubes in mechanically ventilated patients in intensive care and the methods to check the posit...Purpose of review: This article reviews the thoracic complications from malpositioned blindly inserted nasogastric feeding tubes in mechanically ventilated patients in intensive care and the methods to check the position and promote safe placement of the feeding tubes. Recent findings: Malpositioned feeding tubes are not included in risk management databases. The reported incidence is 1-3% and more than half occur in mechanically ventilated patients. Eighty three mechanically ventilated patients were reported with malpositioned nasogastric tubes and 66% of them developed serious thoracic complications. Pneumothoraces accounted for 80% of thoracic complications that were evenly distributed between tubes with and without stylet. Repeated misplacements appear to increase the risk. Non-radiological confirmation of the position of the tube has suboptimal performance. Protocols to place feeding tubes and new technology are promising candidates. Summary: Malpositioned nasogastric feeding tubes are underreported and associated with serious thoracic complications in mechanically ventilated patients. We need more data to answer whether we can afford to prevent them.展开更多
Objective: To determine the prevalence of chro- nic obstructive pulmonary disease (COPD) in adults with Human Immunodeficiency virus infection (HIV). Design: Systematic review of Medline, Embase, CINAHL, PsycINFO and ...Objective: To determine the prevalence of chro- nic obstructive pulmonary disease (COPD) in adults with Human Immunodeficiency virus infection (HIV). Design: Systematic review of Medline, Embase, CINAHL, PsycINFO and references from identified papers. Study selection: Studies determining the prevalence of COPD in adults with HIV infection. Independent duplicate data extraction. Study quality was assessed in terms of whether consecutive patients were en- rolled, recruitment and follow-up periods were defined, 60% males, 60% on antiretroviral therapy. COPD was diagnosed by post-bronchodilator FEV1/FVC < 0.7 in three studies, by International Classification of Diseases (ICD-9) codes in three studies, by FEV1/FVC < 5% of lower adjusted normal in one and by pre- bronchodilator FEV1/FVC < 0.7 in another study. The prevalence was 10% - 35%, except for one study that recorded prevalence of 4% by postbronchodilator FEV1/FVC < 0.7, but <38% of patients with prebronchodilator FEV1/FVC < 0.7 had post-bronchodilator spirometry in that study. Conclusion: COPD is becoming increasingly common in HIV infected as they smoke and live longer due to efficient antiretrovirals. However, definite conclusions cannot be drawn and more longitudinal studies are needed. In the meantime health care providers should be vigilant to screen for undiagnosed COPD and hesitant to attribute respiratory symptoms solely to HIV infection.展开更多
It is not clear what is the appropriate timing to follow-up patients with ventilator-associated pneumonia (VAP) and Clinical Pulmonary Infe- ction Score >6 between days 3-5 of an appro- priate antibiotic treatment....It is not clear what is the appropriate timing to follow-up patients with ventilator-associated pneumonia (VAP) and Clinical Pulmonary Infe- ction Score >6 between days 3-5 of an appro- priate antibiotic treatment. We studied 122 patients with Pseudomonas aeruginosa VAP. A follow-up respiratory sample was collected on days three or five ( “day-three” and “day-five” group ) and treatment was modified 48h later. Molecular typing identified super-infections or persistence. For serial data another respiratory sample was collected, on day three from the “day-five” group and on day five from the “day-three” group. Sixty patients, in the “day- three” group compared to 62 in the “day-five” group, had reduced fourteen-day mortality ( 18.3% and 38.7%;p=0.01 ) and fewer days in intensive care unit (17.2 ± 4.3 compared to 27.3 ± 4.7, p6, improved fourteen-day mortality and shorter duration of stay in health-care facilities were observed with earlier follow-up.展开更多
文摘Purpose of review: This article reviews the thoracic complications from malpositioned blindly inserted nasogastric feeding tubes in mechanically ventilated patients in intensive care and the methods to check the position and promote safe placement of the feeding tubes. Recent findings: Malpositioned feeding tubes are not included in risk management databases. The reported incidence is 1-3% and more than half occur in mechanically ventilated patients. Eighty three mechanically ventilated patients were reported with malpositioned nasogastric tubes and 66% of them developed serious thoracic complications. Pneumothoraces accounted for 80% of thoracic complications that were evenly distributed between tubes with and without stylet. Repeated misplacements appear to increase the risk. Non-radiological confirmation of the position of the tube has suboptimal performance. Protocols to place feeding tubes and new technology are promising candidates. Summary: Malpositioned nasogastric feeding tubes are underreported and associated with serious thoracic complications in mechanically ventilated patients. We need more data to answer whether we can afford to prevent them.
文摘Objective: To determine the prevalence of chro- nic obstructive pulmonary disease (COPD) in adults with Human Immunodeficiency virus infection (HIV). Design: Systematic review of Medline, Embase, CINAHL, PsycINFO and references from identified papers. Study selection: Studies determining the prevalence of COPD in adults with HIV infection. Independent duplicate data extraction. Study quality was assessed in terms of whether consecutive patients were en- rolled, recruitment and follow-up periods were defined, 60% males, 60% on antiretroviral therapy. COPD was diagnosed by post-bronchodilator FEV1/FVC < 0.7 in three studies, by International Classification of Diseases (ICD-9) codes in three studies, by FEV1/FVC < 5% of lower adjusted normal in one and by pre- bronchodilator FEV1/FVC < 0.7 in another study. The prevalence was 10% - 35%, except for one study that recorded prevalence of 4% by postbronchodilator FEV1/FVC < 0.7, but <38% of patients with prebronchodilator FEV1/FVC < 0.7 had post-bronchodilator spirometry in that study. Conclusion: COPD is becoming increasingly common in HIV infected as they smoke and live longer due to efficient antiretrovirals. However, definite conclusions cannot be drawn and more longitudinal studies are needed. In the meantime health care providers should be vigilant to screen for undiagnosed COPD and hesitant to attribute respiratory symptoms solely to HIV infection.
文摘It is not clear what is the appropriate timing to follow-up patients with ventilator-associated pneumonia (VAP) and Clinical Pulmonary Infe- ction Score >6 between days 3-5 of an appro- priate antibiotic treatment. We studied 122 patients with Pseudomonas aeruginosa VAP. A follow-up respiratory sample was collected on days three or five ( “day-three” and “day-five” group ) and treatment was modified 48h later. Molecular typing identified super-infections or persistence. For serial data another respiratory sample was collected, on day three from the “day-five” group and on day five from the “day-three” group. Sixty patients, in the “day- three” group compared to 62 in the “day-five” group, had reduced fourteen-day mortality ( 18.3% and 38.7%;p=0.01 ) and fewer days in intensive care unit (17.2 ± 4.3 compared to 27.3 ± 4.7, p6, improved fourteen-day mortality and shorter duration of stay in health-care facilities were observed with earlier follow-up.
