Evaluation of gastric emptying in critically ill patients using electrical impedance method: a pilot study.

Nasogastric feeding is commonly used to deliver enteral feed in critically ill patients and several methods are used for assessing the gastric residual volume with limitations. A new approach for gastric emptying time measurement has been developed using Electric Impedance Method (EIM). The study aims to establish whether EIM is useful for measuring gastric emptying during nasogastric feeding compared with nasogastric suction. The pilot study was performed among the patients in the Intensive Care Unit (ICU), Bangladesh, from 2018 to 2019. Enteral feed was given to patients by NG tube. Gastric emptying and Gastric Residual Volume (GRV) were measured using EIM and nasogastric suction tube. Patterns of filling and emptying were almost the same in all subjects but emptying time varied between individuals that correlated well with GRV in 16 patients. Therefore, the study showed that the measurement of gastrc volume by the non-invasive and hazard-free electrical impedance method has a high specificity (90%) and efficacy of 80%. The study also revealed significant changes in gastric emptying time due to different body statuses. EIM seemed to be capable of measuring gastric emptying over time. EIM could become a standard tool for monitoring gastric emptying in patients at risk of gastroparesis.

Managing Severe Tetanus without Ventilation Support in a Resource-limited Setting in Bangladesh.

Tetanus, a vaccine-preventable and potentially fatal disease, continues to remain prevalent in low- and middle-income countries. Furthermore, physicians are often unfamiliar with management of severe tetanus without ventilator support. Therefore, we proposed a modified treatment protocol that provides a low-cost and effective solution for the management of severe tetanus in resource-constrained settings. This is an observational study of 42 patients with severe tetanus treated during 2015-2016 at Surya Kanta Hospital, Bangladesh. This facility does not have an intensive care unit (ICU), and patients admitted here were provided treatment with the modified protocol. A total number of 42 patients with severe tetanus were treated with the modified protocol. Among them, 24 (57.1%) recovered completely, six (14.3%) recovered with the sequela, and 12 (28.6%) died. Among those who recovered with the sequela, four needed mechanical support during walking and two had a visual impairment. No significant adverse event was recorded during the treatment period. The results gathered during this case series provide a sustainable, low-cost, and effective solution to management of severe tetanus in resource-constrained settings where ICUs are unavailable.