Administração de nutrição enteral em posição prona, volume de resíduo gástrico e outros desfechos clínicos em pacientes críticos: uma revisão sistemática / Administration of enteral nutrition in the prone position, gastric residual volume and other clinical outcomes in critically ill patients: a systematic review

RESUMO Esta revisão sistemática de estudos longitudinais objetivou avaliar o efeito da administração da dieta enteral em pacientes críticos adultos e pediátricos em posição prona no volume residual gástrico e em outros desfechos clínicos. A busca da literatura foi conduzida nas bases de dados PubMed®, Scopus e Embase, a partir de termos relacionados à população e à intervenção. Dois revisores independentes analisaram os títulos e resumos, e a coleta dos dados foi realizada a partir de uma ficha padronizada. Discrepâncias foram resolvidas por um terceiro revisor. A qualidade metodológica dos estudos foi avaliada considerando o potencial para erros sistemáticos e os dados analisados qualitativamente. Quatro estudos com pacientes adultos e um com pacientes pré-termos foram incluídos. O volume residual gástrico foi avaliado como principal desfecho: três não diferiram no volume residual gástrico entre as posições prona e supina (p > 0,05), enquanto um estudo demonstrou maior volume residual gástrico durante a administração da dieta em posição prona (27,6mL versus 10,6mL; p < 0,05), e outro apresentou maior volume residual gástrico na posição supina (redução do volume residual gástrico de 23,3% na posição supina versus 43,9% na posição prona; p < 0,01). Dois estudos avaliaram a frequência de vômitos, sendo maior na posição prona em um estudo (30 versus 26 episódios; p < 0,001) e sem diferença significativa em outro (p > 0,05). Incidência de pneumonia aspirativa e de óbito foram avaliadas por um estudo, não sendo observada diferença entre os grupos (p > 0,05). A literatura acerca da administração de dieta enteral em pacientes críticos em posição prona é escassa e de qualidade limitada, e os resultados sobre volume residual gástrico são contraditórios. Estudos observacionais com tamanho amostral apropriado deveriam ser conduzidos para fundamentar conclusões sobre o tema.

ABSTRACT This systematic review of longitudinal studies aimed to evaluate the effect of enteral feeding of critically ill adult and pediatric patients in the prone position on gastric residual volume and other clinical outcomes. A literature search was conducted in the databases PubMed, Scopus and Embase using terms related to population and intervention. Two independent reviewers analyzed the titles and abstracts, and data collection was performed using a standardized form. Discrepancies were resolved by a third reviewer. The methodological quality of the studies was evaluated considering the potential for systematic errors, and the data were qualitatively analyzed. Four studies with adult patients and one with preterm patients were included. The gastric residual volume was evaluated as the main outcome: three studies did not show differences in the gastric residual volume between the prone and supine positions (p > 0.05), while one study showed a higher gastric residual volume during enteral feeding in the prone position (27.6mL versus 10.6mL; p < 0.05), and another group observed a greater gastric residual volume in the supine position (reduction of the gastric residual volume by 23.3% in the supine position versus 43.9% in the prone position; p < 0.01). Two studies evaluated the frequency of vomiting; one study found that it was higher in the prone position (30 versus 26 episodes; p < 0.001), while the other study found no significant difference (p > 0.05). The incidence of aspiration pneumonia and death were evaluated in one study, with no difference between groups (p > 0.05). The literature on the administration of enteral feeding in the prone position in critically ill patients is sparse and of limited quality, and the results regarding gastric residual volume are contradictory. Observational studies with appropriate sample sizes should be conducted to support conclusions on the subject.

Ultrasonido para la valoración del contenido gástrico: revisión sistemática de la literatura / Ultrasound for the assessment of gastric content: a systematic review

INTRODUCTION: Pneumonic aspiration of gastric contents is an important complication of anesthetic practice. : OBJECTIVE: To determine the applicability of ultrasound for the assessment of the qualitative and quantitative characteristics of gastric contents. MATERIAL AND METHODS: A systematic review was carried out, based on a structured search of the literature published in the databases: Pubmed, EMBASE, SciELO, Cochrane Library, OVID and Google Scholar, from the foundation of these until December 2018 Boolean connectors were used to locate information from the terms: anesthesiology, ultrasonography, gastrointestinal Contents. The quality of the information was assessed using different tools according to each type of study. RESULTS: We found 23 relevant studies for inclusion in the systematic review. The overall risk of bias was low. CONCLUSIONS: Gastric ultrasound seems to correspond to a tool that is easy to perform at the patient's bedside, but there is uncertainty about its applicability in uncontrolled settings, different from those applied in the studies described in this review. More research is needed with different populations and scenarios, in favor of establishing the behavior in these, of the variables that can be determined by ultrasound. The implications for clinical practice and long-term outcomes may have the measurements achieved by ultrasound are still uncertain.

INTRODUCCIÓN: La aspiración neumónica del contenido gástrico es una complicación importante de la práctica anestésica. OBJETIVO: Determinar la aplicabilidad del ultrasonido para la valoración de las características cualitativas y cuantitativas del contenido gástrico. MATERIALES Y MÉTODOS: Se realizó una revisión sistemática, a partir de una búsqueda estructurada de la literatura publicada en las bases de datos: Pubmed, EMBASE, SciELO, Cochrane Library, OVID y Google Scholar, desde la fundación de las mismas hasta diciembre de 2018. Se utilizaron conectores booleanos para localizar información a partir de los términos: anesthesiology, ultrasonography, gastrointestinal Contents. La calidad de la información fue valorada mediante diferentes herramientas de acuerdo a cada tipo de estudio. RESULTADOS: Se encontraron 23 estudios pertinentes para su inclusión en la revisión sistemática. El riesgo global de sesgo fue bajo. CONCLUSIONES: El ultrasonido gástrico parece corresponder a una herramienta de fácil realización a la cabecera del paciente, pero existe incertidumbre sobre su aplicabilidad en contextos no controlados, diferentes a los aplicados en los estudios descritos en la presente revisión. Se necesita más investigación con distintas poblaciones y escenarios, en favor de establecer el comportamiento en estos, de las variables que pueden determinarse por ultrasonido. Las implicaciones que para la práctica clínica y desenlaces a largo plazo puedan tener las mediciones logradas mediante ecografía son aún inciertas.

Clinical assessment of gastric contents before cesarean section: antral cross-sectional area measured using ultrasonography / 中华麻醉学杂志

Objective To assess the gastric contents before cesarean section using antral cross-sectional area (CSA) measured by ultrasonography.Methods One hundred and seventy-seven American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients,aged 20-44 yr,undergoing cesarean section,were enrolled in this study.The antral CSA in the semi-recumbent and right lateral decubitus positions was measured through the ultrasound images of the antrum in the sagittal plane below xiphoid before anesthesia and qualitatively graded.Qualitative grade 0 was considered as the gold standard,and the receiver operating characteristic (ROC) curve of CSA in assessing the preoperative gastric contents was plotted.Results The critical value of ROC curve of CSA in the semi-recumbent position was 6.025 cm2.The critical value of ROC curve of CSA in the right lateral decubitus position was 9.095 cm2.Conclusion CSA ＜ 6.025 cm2 measured by ultrasonography in the semi-recumbent position or CSA＜9.095 cm2 measured by ultrasonography in the right lateral decubitus position can confirm that the gastric emptying state is achieved before cesarean section.

Correlation between Movement Distance of Small Intestinal Contents and Survival Time in Female Rats after Feeding / 法医学杂志

OBJECTIVES@#To study the correlation between the movement distance of small intestinal contents and survival time in female SD rat models after one-time satiation, and to evaluate its application value for postmortem interval estimation.@*METHODS@#Adult female SD rats were randomly divided into postprandial groups （1, 2, 3, 4 and 5 h after feeding） and control group. The postprandial groups were fed for 1 h, meanwhile control group was kept fasting. All rats were sacrificed at the given time. The contents in stomach and small intestine were observed, described, compared and photographed, and the movement distance of small intestinal contents was measured. The data of postprandial groups were analysed by one-way analysis of variance.@*RESULTS@#The stomach and duodenum of control group were empty with a little thin and yellow small intestinal liquid. The gastral cavities of 1 h postprandial group were full of undigested food. The evolutionary changes of character, colour and content were observed in the gastric and small intestinal contents of other postprandial groups. The movement distance of intestinal contents increased while the empty part decreased gradually. The differences among the postprandial groups were statistically significant （P<0.05）.@*CONCLUSIONS@#After a 24 h fasting with free drinking and the following 1 h feeding, an ideal animal model can be established successfully on female SD rats, which can provide an experimental basis for postmortem interval estimation based on the changes of small intestinal contents in forensic practice.

Gastrointestinal Gas and Abdominal Fat Quantity Measured by Three-Dimensional Abdominal Computed Tomography in Patients with Functional Bloating / 대한소화기학회지

BACKGROUND/AIMS: The aim of this study was to assess whether increased intestinal gas or fat content in the abdominal cavity is related to abdominal bloating, using three-dimensional abdominal computed tomography scan. METHODS: Twenty-nine healthy individuals without abdominal bloating and organic disease (15 women; mean age, 49 years; range of age, 23–73 years) and 30 patients with chronic recurrent abdominal bloating-diagnosed with functional bloating (10 women; mean age, 53 years; range of age, 35–75 years) - participated in this study. The mean values of measured parameters were compared using independent sample t-test. RESULTS: The mean volume of total colon gas in bloated patients was similar to that in control subjects. The distribution of intra-abdominal gas was also similar between the two groups. However, the amount of gas in the transverse colon tended to be significantly higher in patients with bloating than in controls (p=0.06). Body mass index was similar between the two groups (23.4±3.2 kg/m2 and 22.3±3.1 kg/m2, respectively). Moreover, no significant differences with respect to circumferential area, subcutaneous fat, visceral fat area, and total fat area were found between the two groups. CONCLUSIONS: Bloating might not just be the result of gastrointestinal gas or intra-abdominal fat. Other contributing factors, such as localized abnormality in gas distribution and visceral hypersensitivity, may be involved.

Value of ultrasonographic measurement of antral cross-sectional area in assessing preoperative gastric content volume in preschool pediatric patients / 中华麻醉学杂志

Objective To evaluate the value of ultrasonographic measurement of the antral crosssectional area (CSA) in assessing the preoperative gastric content volume in preschool pediatric patients.Methods Fifty American Society of Anesthesiologists physical status Ⅰ or Ⅱ pediatric patients of both sexes,aged ＜7 yr,undergoing elective non-gastrointestinal surgery,were fasted according to the preoperative fasting guidelines recommended by American Society of Anesthesiologists.Sedation was performed with intravenously injected midazolam or with intravenously injected midazolam and propofol after admission to the operating room.The antral CSA in the supine and right lateral decubitus positions was measured using bedside ultrasonography and free tracing method.A gastric tube was inserted after gastric sonography to collect the gastric fluid,and the total volume of the gastric fluid was considered to be the gastric content volume.Results Six pediatric patients were excluded due to the unsatisfactory ultrasound image,and 44 pediatric patients were included.Gastric content volume and gastric content volume per kilogram of body weight were positively correlated with the antral CSA in the right lateral decubitus position,and the Spearman correlation coefficients were 0.48 (P＜0.01) and 0.37 (P＜0.05),respectively.There was no correlation between gastric content volume and gastric content volume per kilogram of body weight and the antral CSA in the supine position (P＞0.05).Conclusion Ultrasonographic measurement of the antral CSA in the right lateral decubitus position can be used to assess the preoperative gastric content volume in preschool pediatric patients.

Sobrecrecimiento bacteriano intestinal en pacientes con pancreatitis crónica / Small intestine bacterial overgrowth in patients with chronic pancreatitis

Background: Previous reports describe 30-40 percent of small intestine bacterial overgrowth (SIBO) in patients with chronic pancreatitis (CP), SIBO is a cause of persistent symptoms in this group of patients even when they are treated with pancreatic enzymes. Aim: To asses the frequency of SIBO in patients with CP. Patients and methods: We studied 14 patients with CP using an hydrogen breath test with lactulose to detect SIBO, a nonabsorbable carbohydrate, whose results are not influenced by the presence of exocrine insufficiency. Main symptoms and signs were bloating in 9 (64 percent), recurrent abdominal pain in 8 (57 percent), intermittent diarrhea in 5 (36 percent) and steatorrhea in 5 (36 percent). At the same time we studied a healthy control group paired by age and sex. Results: SIBO was present in 13 of 14 patients with CP (92 percent) and in 1 of 14 controls (p<0.001). The only patient with CP and without SIBO was recently diagnosed and had minimal morphologic alterations in computed tomography and endoscopic pancreatography Conclusions: SIBO is common in CP and may be responsible for persistent symptoms. Proper diagnosis and treatment could alleviate symptoms and improve quality of life.

Investigation on Campylobacter carrier state of bile and intestinal content of domestic animals and fowls / 第三军医大学学报

The Campylobacter carrier rate of the bile was 23. 64%,14. 29%,7. 14%,6. 64%,5.88%, 5.55% and 3. 63% in the quails, cats, dogs, pigs, chickens, ducks and oxen respectively. The survival time of Campylobacter in the bile in vitro ranged from 4 to 7 weeks. The Campylobacter carrier rate of the intestinal content was higher than that of the bile in all the domestic animals and fowls. It is believed that the domestic animals and fowls may be an important source of Campylobacter infection in human beings according to our findings.