tailieunhanh - Critical Care Focus 9: The Gut - part 3

Nếu sau 30 phút, ống không được đưa vào ruột non, một kỹ thuật cạnh giường siêu âm được sử dụng. Các phương pháp hướng dẫn mù đã thành công trong chỉ có 25 7% bệnh nhân. Thời gian trung bình cho vị trí của các ống dẫn thức ăn với kỹ thuật này hướng dẫn sử dụng là 13 9 phút. | CRITICAL CARE FOCUS THE GUT successful placement was confirmed by x ray film. If after 30 min the tube did not enter the small bowel a sonographic bedside technique was used. The blind manual method was successful in only 25-7 of patients. The average time for placement of the feeding tubes with this manual technique was 13-9 min. The ultrasound technique was successful in 84-6 of the remaining patients and the average time for placement 18-3 min. Much more commonly and definitely more successful if the expertise is available is to use the Seldinger technique of endoscopic tube placement. Grathwohl and colleagues14 described bedside videoscopic placement using a fibreoptic scope through the feeding tube in healthy volunteers and critically ill patients. Standard feeding tubes were placed under direct vision using a 2-2mm fibreoptic scope through the feeding tube. Enteric structures were clearly seen through the feeding tube in all subjects and patients and the feeding tube could be advanced through the pylorus and into the duodenum based on visual landmarks in all individuals. Transpyloric tube placement was confirmed videoscopically and radiographically. This new technique obviously has the potential for rapid accurate and safe feeding tube placement in patients requiring nutritional support. Patient position The prone position can be effective in mechanically ventilated patients to improve oxygenation but this position may affect gastric emptying and the ability to continue enteral feeding. However Van der Voort15 determined the tolerance of enteral feeding in enterally fed patients during supine and prone positions and found little difference in gastric residual volume between positions. The authors suggested that patients with a clinically significant gastric residual volume in one position are likely to have a clinically significant gastric residual volume in the other position. Summary In summary my personal approach to the problem of delayed gastric emptying