Rates and Determinants of Home Nasogastric Tube Feeding in Infants Born Very Preterm.

OBJECTIVE: To examine rates and determinants of home nasogastric (NG)-tube feeding at hospital discharge in a cohort of very preterm infants within the Canadian Neonatal Network (CNN). STUDY DESIGN: This was a population-based cohort study of infants born <33 weeks of gestation and admitted to neonatal intensive care units (NICUs) participating in the CNN between January 1, 2010, and December 31, 2018. We excluded infants who had major congenital anomalies, required gastrostomy-tube, or were discharged to non-CNN facilities. Multivariable logistic regression analysis was used to identify independent determinants of home NG-tube feeding at hospital discharge. RESULTS: Among the 13 232 infants born very preterm during the study period, 333 (2.5%) were discharged home to receive NG-tube feeding. Rates of home NG-tube feeding varied across Canadian NICUs, from 0% to 12%. Determinants of home NG-tube feeding were gestational age (aOR 0.94 per each gestational week increase, 95% CI 0.88-0.99); duration of mechanical ventilation (aOR 1.02 per each day increase, 95% CI 1.01-1.02); high illness severity at birth (aOR 1.32, 95% CI 1.01-1.74); small for gestational age (aOR 2.06, 95% CI 1.52-2.78); male sex (aOR 0.61, 95% CI 0.49-0.77); severe brain injury (aOR 1.60, 95% CI 1.10-2.32); and bronchopulmonary dysplasia (aOR 2.22, 95% CI 1.67-2.94). CONCLUSIONS: Rates of home NG-tube feeding varied widely between Canadian NICUs. Higher gestational age and male sex reduced the odds of discharge home to receive NG-tube feeding; and in contrast small for gestational age, severe brain injury, prolonged duration on mechanical ventilation and bronchopulmonary dysplasia increased the odds.

Cost-effective modified endoscopic vacuum therapy for the treatment of gastrointestinal transmural defects: step-by-step process of manufacturing and its advantages.

Video 1Cost-effective modified endoscopic vacuum therapy for GI transmural defects. Step-by-step process of manufacturing and potential advantages.1.Cut half gauze to the ideal size to cover only the fenestrated portion of the nasogastric tube (NGT).2.Wrap the gauze around the fenestrated portion of the NGT. The assistance of another person is important in this process.3.Cut the antimicrobial incise drape to match the size of the fenestrated portion of the NGT. Note that the incise drape is a very strong adhesive; therefore, 3 people are usually required to assemble it properly.4.Next, the suture is used to fix the gauze and drape to the NGT. Perform fixation of the modified sponge in 3 places. The first knot is in the proximal portion, just below the last fenestra of the NGT, as a marker of where the vacuum system starts. The second knot is at the distal end, to avoid migration of the modified sponge. The third knot is in the middle of the modified sponge, which is essential to serve as a guide during endoscopic placement. For example, in cases of defects without collection in which the sponge will be placed in an intraluminal position, it is ideal to place the vacuum system in the middle of the defect; in cases of intracavitary placement, it will work as a guide to how much of the modified sponge will be inside the collection.5.Finally, use a needle to make innumerable punctures in the modified sponge system to obtain adequate aspiration. An 18G needle is recommended because, in addition to having an adequate diameter, it is very sharp, which facilitates perforation of the modified sponge system.6.After creation of the modified endoscopic vacuum therapy, the functionality test is performed. Turn on the wall suction system, connect the distal end of the NGT to the tube of the canister connected on the wall, and place the NGT inside a bowl with a liquid solution. The aspiration of a large amount of liquid indicates proper functioning of the modified endoscopic vacuum therapy system.7.The device is then ready to be positioned endoscopically in the patient. After proper positioning, connect the NGT to the suction tube to avoid migration of the device upon removal of the scope.8.In addition to the cost-effective device as described, in our practice we also use wall suction to reduce costs associated with the use of the vacuum machine.9.Use the antimicrobial incise drape to seal the connection between the NGT and the suction tube to avoid leakage within the connection.10.Last, owing to instability of the negative wall pressure, a 20F intravenous catheter is connected to the tube to maintain a negative pressure between -75 and -150 mmHg, as confirmed by laboratory studies performed by our group.

Nutrición en pancreatitis aguda: nuevos conceptos para un viejo problema / Nutrition in acute pancreatitis: new concepts for an old problem

Resumen El manejo de la nutrición en pancreatitis aguda ha sido cuestión de debate. Durante muchos años el concepto de reposo pancreático fue generalizado y aceptado en el manejo de la pancreatitis aguda. Actualmente se conoce que la nutrición temprana permite mantener la integridad de la barrera intestinal, que previene la aparición de complicaciones infeccionas y se asocia con una menor estancia hospitalaria, menos complicaciones y un mejor pronóstico. En esta revisión se discuten las principales ventajas de la nutrición temprana en pancreatitis aguda, la seguridad de la misma y la vía de administración.

Abstract Nutrition management in acute pancreatitis has been a matter of debate worldwide. For many years, the concept of pancreatic rest was widespread and accepted to treat acute pancreatitis. However, current knowledge of early nutrition allows maintaining the intestinal barrier's integrity, preventing the occurrence of infectious complications, which is associated with a shorter hospital stay, fewer complications, and better prognosis. This review presents the main advantages of early nutrition in acute pancreatitis, its safety, and the route of administration.

Gastrostomy Tube Feeding in Extremely Low Birthweight Infants: Frequency, Associated Comorbidities, and Long-term Outcomes.

OBJECTIVE: To assess the frequency of gastrostomy tube (GT) placement in extremely low birth weight (ELBW) infants, associated comorbidities, and long-term outcomes. STUDY DESIGN: Analysis of ELBW infants from 25 centers enrolled in the National Institute of Child Health and Human Development Neonatal Research Network's Generic Database and Follow-up Registry from 2006 to 2012. Frequency of GT placement before 18-22 months, demographic and medical factors associated with GT placement, and associated long-term outcomes at 18-22 months of corrected age were described. Associations between GT placement and neonatal morbidities and long-term outcomes were assessed with logistic regression after adjustment for center and common co-variables. RESULTS: Of the 4549 ELBW infants included in these analyses, 333 (7.3%) underwent GT placement; 76% had the GT placed postdischarge. Of infants with GTs, 11% had birth weights small for gestational age, 77% had bronchopulmonary dysplasia, and 29% severe intraventricular hemorrhage or periventricular leukomalacia. At follow-up, 56% of infants with a GT had weight <10th percentile, 61% had neurodevelopmental impairment (NDI), and 55% had chronic breathing problems. After adjustment, small for gestational age, bronchopulmonary dysplasia, intraventricular hemorrhage/periventricular leukomalacia, poor growth, and NDI were associated with GT placement. Thirty-two percent of infants with GTs placed were taking full oral feeds at follow-up. CONCLUSIONS: GT placement is common in ELBW infants, particularly among those with severe neonatal morbidities. GT placement in this population was associated with poor growth, NDI, and chronic respiratory and feeding problems at follow-up. The frequency of GT placement postneonatal discharge indicates the need for close nutritional follow-up of ELBW infants. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00063063.

Nudo en la porción distal de la sonda nasogástrica: una complicación poco común posterior a su colocación / Knot in the distal portion of the nasogastric tube: an uncommon complication after its placement / Nó na porção distal da sonda nosogástrica: uma complicação rara após a colocação

Resumen Presentamos el caso clínico de un paciente que manifestó un anudamiento en la porción distal de una sonda nasogástrica, sin complicaciones, y realizamos una breve revisión de las posibles complicaciones asociadas al uso de este tipo de dispositivos.

Abstract We report the case of a patient who presented a knot in the distal portion of a nasogastric tube, without transcendence, and perform a brief review of the possible complications associated with the use of this type of devices.

Resumo Apresentamos o caso de um paciente que apresentou um nó na porção distal da sonda nasogástrica sem complicações. Realizamos uma breve revisão das possíveis complicações associadas ao uso deste tipo de dispositivos.

Enteral electrolyte solutions with different osmolarities administered in a continuous flow in newborn calves / Soluções eletrolíticas enteral com diferentes osmolaridade administradas em fluxo contínuo em bezerros recém-nascidos

This study compared the effects of enteral electrolyte solutions with different osmolarities in Holstein cattle. Eighteen newborn calves were evenly divided into three groups and administered the following treatments: hypotonic electrolyte solution (ESHYPO) containing 4g NaCl, 0.5g KCl, 1g sodium acetate, and 7.5g dextrose diluted in 1,000mL water; isotonic electrolyte solution (ESISO) containing 5g NaCl, 1g KCl, 2g sodium acetate, and 10g dextrose diluted in 1,000mL water; and hypertonic electrolyte solution (ESHYPER) containing 6g NaCl, 1g KCl, 3g sodium acetate, and 15g dextrose diluted in 1,000mL water. Solutions were administered at a rate of 15mL kg-1hr-1 for 12 hours in a continuous flow. All three solutions increased the concentration of plasma sodium, but ESHYPO did not alter the serum osmolarity. Both ESISO and ESHYPO resulted in an increase in volemia.

O presente estudo comparou os efeitos de soluções de eletrolíticas enterais com diferentes osmolaridades administradas em fluxo contínuo. Dezoito animais foram divididos em três grupos: Solução eletrolítica hipotônica (SEHIPO) contendo 4g de NaCl; 0,5g de KCl; 1g de acetato de sódio; 7,5g de dextrose diluídos em 1.000mL de água; Solução eletrolítica isotônica (SEISO) contendo 5g de NaCl; 1g de KCl; 2g de acetato de sódio; 10g de dextrose diluídos em 1.000mL de água; A solução eletrolítica hipertônica (SEHIPER) contendo 6g de NaCl; 1g de KCl; 3g de acetato de sódio; 15g de dextrose diluídos em 1.000mL de água. As soluções foram administradas na dose de 15mLkg-126h-1 durante 12 horas. Os tratamentos SEHIPO, SEISO e SEHIPER aumentaram a concentração plasmática de sódio, contudo apenas a SEHIPO não ocasionou alteração na osmolaridade sérica. As SEHIPO e SEISO aumentaram a volemia.

Enteral electrolyte solutions with different osmolarities administered in a continuous flow in newborn calves / Soluções eletrolíticas enteral com diferentes osmolaridade administradas em fluxo contínuo em bezerros recém-nascidos

This study compared the effects of enteral electrolyte solutions with different osmolarities in Holstein cattle. Eighteen newborn calves were evenly divided into three groups and administered the following treatments: hypotonic electrolyte solution (ESHYPO) containing 4g NaCl, 0.5g KCl, 1g sodium acetate, and 7.5g dextrose diluted in 1,000mL water; isotonic electrolyte solution (ESISO) containing 5g NaCl, 1g KCl, 2g sodium acetate, and 10g dextrose diluted in 1,000mL water; and hypertonic electrolyte solution (ESHYPER) containing 6g NaCl, 1g KCl, 3g sodium acetate, and 15g dextrose diluted in 1,000mL water. Solutions were administered at a rate of 15mL kg-1hr-1 for 12 hours in a continuous flow. All three solutions increased the concentration of plasma sodium, but ESHYPO did not alter the serum osmolarity. Both ESISO and ESHYPO resulted in an increase in volemia.(AU)

O presente estudo comparou os efeitos de soluções de eletrolíticas enterais com diferentes osmolaridades administradas em fluxo contínuo. Dezoito animais foram divididos em três grupos: Solução eletrolítica hipotônica (SEHIPO) contendo 4g de NaCl; 0,5g de KCl; 1g de acetato de sódio; 7,5g de dextrose diluídos em 1.000mL de água; Solução eletrolítica isotônica (SEISO) contendo 5g de NaCl; 1g de KCl; 2g de acetato de sódio; 10g de dextrose diluídos em 1.000mL de água; A solução eletrolítica hipertônica (SEHIPER) contendo 6g de NaCl; 1g de KCl; 3g de acetato de sódio; 15g de dextrose diluídos em 1.000mL de água. As soluções foram administradas na dose de 15mLkg-126h-1 durante 12 horas. Os tratamentos SEHIPO, SEISO e SEHIPER aumentaram a concentração plasmática de sódio, contudo apenas a SEHIPO não ocasionou alteração na osmolaridade sérica. As SEHIPO e SEISO aumentaram a volemia.(AU)

Enteral electrolyte solutions with different osmolarities administered in a continuous flow in newborn calves / Soluções eletrolíticas enteral com diferentes osmolaridade administradas em fluxo contínuo em bezerros recém-nascidos

ABSTRACT: This study compared the effects of enteral electrolyte solutions with different osmolarities in Holstein cattle. Eighteen newborn calves were evenly divided into three groups and administered the following treatments: hypotonic electrolyte solution (ESHYPO) containing 4g NaCl, 0.5g KCl, 1g sodium acetate, and 7.5g dextrose diluted in 1,000mL water; isotonic electrolyte solution (ESISO) containing 5g NaCl, 1g KCl, 2g sodium acetate, and 10g dextrose diluted in 1,000mL water; and hypertonic electrolyte solution (ESHYPER) containing 6g NaCl, 1g KCl, 3g sodium acetate, and 15g dextrose diluted in 1,000mL water. Solutions were administered at a rate of 15mL kg-1hr-1 for 12 hours in a continuous flow. All three solutions increased the concentration of plasma sodium, but ESHYPO did not alter the serum osmolarity. Both ESISO and ESHYPO resulted in an increase in volemia.

RESUMO: O presente estudo comparou os efeitos de soluções de eletrolíticas enterais com diferentes osmolaridades administradas em fluxo contínuo. Dezoito animais foram divididos em três grupos: Solução eletrolítica hipotônica (SEHIPO) contendo 4g de NaCl; 0,5g de KCl; 1g de acetato de sódio; 7,5g de dextrose diluídos em 1.000mL de água; Solução eletrolítica isotônica (SEISO) contendo 5g de NaCl; 1g de KCl; 2g de acetato de sódio; 10g de dextrose diluídos em 1.000mL de água; A solução eletrolítica hipertônica (SEHIPER) contendo 6g de NaCl; 1g de KCl; 3g de acetato de sódio; 15g de dextrose diluídos em 1.000mL de água. As soluções foram administradas na dose de 15mLkg-126h-1 durante 12 horas. Os tratamentos SEHIPO, SEISO e SEHIPER aumentaram a concentração plasmática de sódio, contudo apenas a SEHIPO não ocasionou alteração na osmolaridade sérica. As SEHIPO e SEISO aumentaram a volemia.

Enteral electrolyte solutions with different osmolarities administered in a continuous flow in newborn calves

ABSTRACT: This study compared the effects of enteral electrolyte solutions with different osmolarities in Holstein cattle. Eighteen newborn calves were evenly divided into three groups and administered the following treatments: hypotonic electrolyte solution (ESHYPO) containing 4g NaCl, 0.5g KCl, 1g sodium acetate, and 7.5g dextrose diluted in 1,000mL water; isotonic electrolyte solution (ESISO) containing 5g NaCl, 1g KCl, 2g sodium acetate, and 10g dextrose diluted in 1,000mL water; and hypertonic electrolyte solution (ESHYPER) containing 6g NaCl, 1g KCl, 3g sodium acetate, and 15g dextrose diluted in 1,000mL water. Solutions were administered at a rate of 15mL kg-1hr-1 for 12 hours in a continuous flow. All three solutions increased the concentration of plasma sodium, but ESHYPO did not alter the serum osmolarity. Both ESISO and ESHYPO resulted in an increase in volemia.

RESUMO: O presente estudo comparou os efeitos de soluções de eletrolíticas enterais com diferentes osmolaridades administradas em fluxo contínuo. Dezoito animais foram divididos em três grupos: Solução eletrolítica hipotônica (SEHIPO) contendo 4g de NaCl; 0,5g de KCl; 1g de acetato de sódio; 7,5g de dextrose diluídos em 1.000mL de água; Solução eletrolítica isotônica (SEISO) contendo 5g de NaCl; 1g de KCl; 2g de acetato de sódio; 10g de dextrose diluídos em 1.000mL de água; A solução eletrolítica hipertônica (SEHIPER) contendo 6g de NaCl; 1g de KCl; 3g de acetato de sódio; 15g de dextrose diluídos em 1.000mL de água. As soluções foram administradas na dose de 15mLkg-126h-1 durante 12 horas. Os tratamentos SEHIPO, SEISO e SEHIPER aumentaram a concentração plasmática de sódio, contudo apenas a SEHIPO não ocasionou alteração na osmolaridade sérica. As SEHIPO e SEISO aumentaram a volemia.

Comparing insertion characteristics on nasogastric tube placement by using GlideScopeTM visualization vs. MacIntosh laryngoscope assistance in anaesthetized and intubated patients / Comparação das características de inserção de sonda nasogástrica, usando visibilização pelo laringoscópio GlideScope® vs. guiada pelo laringoscópio MacIntosh em pacientes anestesiados e intubados

Abstract Background and objective: This was a prospective, randomized clinical study to compare the success rate of nasogastric tube insertion by using GlideScopeTM visualization versus direct MacIntosh laryngoscope assistance in anesthetized and intubated patients. Methods: Ninety-six ASA I or II patients, aged 18-70 years were recruited and randomized into two groups using either technique. The time taken from insertion of the nasogastric tube from the nostril until the calculated length of tube had been inserted was recorded. The success rate of nasogastric tube insertion was evaluated in terms of successful insertion in the first attempt. Complications associated with the insertion techniques were recorded. Results: The results showed success rates of 74.5% in the GlideScopeTM Group as compared to 58.3% in the MacIntosh Group (p = 0.10). For the failed attempts, the nasogastric tube was successfully inserted in all cases using rescue techniques. The duration taken in the first attempt for both techniques was not statistically significant; Group A was 17.2 ± 9.3 s as compared to Group B, with a duration of 18.9 ± 13.0 s (p = 0.57). A total of 33 patients developed complications during insertion of the nasogastric tube, 39.4% in Group A and 60.6% in Group B (p = 0.15). The most common complications, which occurred, were coiling, followed by bleeding and kinking. Conclusion: This study showed that using the GlideScopeTM to facilitate nasogastric tube insertion was comparable to the use of the MacIntosh laryngoscope in terms of successful rate of insertion and complications.

Resumo Justificativa e objetivo: Este foi um estudo clínico prospectivo e randômico para comparar a taxa de sucesso da inserção de sonda nasogástrica (NG) com as técnicas de visibilização guiada pelo laringoscópio GlideScope® versus guiada pelo laringoscópio MacIntosh em pacientes anestesiados e intubados. Métodos: Foram recrutados 96, ASA I ou II, entre 18-70 anos, e divididos randomicamente em dois grupos, com uma ou outra técnica. Foi calculado o tempo transcorrido desde a inserção da sonda NG, da narina até a inserção do comprimento calculado da sonda. A taxa de sucesso de inserção da sonda NG foi avaliada quanto à inserção bem-sucedida na primeira tentativa. As complicações associadas às técnicas de inserção foram registradas. Resultados: Os resultados mostraram taxas de sucesso de 74,5% para o grupo GlideScope® em comparação com 58,3% para o grupo MacIntosh (p = 0,10). Para as tentativas que falharam, a sonda NG foi inserida com sucesso em todos os casos, com as técnicas de resgate. A duração da primeira tentativa para ambas as técnicas não foi estatisticamente significativa: 17,2 ± 9,3 segundos no Grupo A e 18,9 ± 13,0 segundos no Grupo B (p = 0,57). No total, 33 pacientes desenvolveram complicações durante a inserção da sonda NG: 39,4% no Grupo A e 60,6% no Grupo B (p = 0,15). As complicações mais comuns ocorridas foram enrolamento, seguido de sangramento e dobradura. Conclusão: Este estudo mostrou que o uso do GlideScope® para facilitar a inserção de sonda nasogástrica foi comparável ao uso do laringoscópio MacIntosh quanto à taxa de sucesso de inserção e às complicações.

Comparing insertion characteristics on nasogastric tube placement by using GlideScope™ visualization vs. MacIntosh laryngoscope assistance in anaesthetized and intubated patients.

BACKGROUND AND OBJECTIVE: This was a prospective, randomized clinical study to compare the success rate of nasogastric tube insertion by using GlideScope™ visualization versus direct MacIntosh laryngoscope assistance in anesthetized and intubated patients. METHODS: Ninety-six ASA I or II patients, aged 18-70 years were recruited and randomized into two groups using either technique. The time taken from insertion of the nasogastric tube from the nostril until the calculated length of tube had been inserted was recorded. The success rate of nasogastric tube insertion was evaluated in terms of successful insertion in the first attempt. Complications associated with the insertion techniques were recorded. RESULTS: The results showed success rates of 74.5% in the GlideScope™ Group as compared to 58.3% in the MacIntosh Group (p=0.10). For the failed attempts, the nasogastric tube was successfully inserted in all cases using rescue techniques. The duration taken in the first attempt for both techniques was not statistically significant; Group A was 17.2±9.3s as compared to Group B, with a duration of 18.9±13.0s (p=0.57). A total of 33 patients developed complications during insertion of the nasogastric tube, 39.4% in Group A and 60.6% in Group B (p=0.15). The most common complications, which occurred, were coiling, followed by bleeding and kinking. CONCLUSION: This study showed that using the GlideScope™ to facilitate nasogastric tube insertion was comparable to the use of the MacIntosh laryngoscope in terms of successful rate of insertion and complications.

[Comparing insertion characteristics on nasogastric tube placement by using GlideScope™ visualization vs. MacIntosh laryngoscope assistance in anaesthetized and intubated patients]. / Comparação das características de inserção de sonda nasogástrica, usando visibilização pelo laringoscópio GlideScope(®) vs. guiada pelo laringoscópio MacIntosh em pacientes anestesiados e intubados.

BACKGROUND AND OBJECTIVE: This was a prospective, randomized clinical study to compare the success rate of nasogastric tube insertion by using GlideScope™ visualization versus direct MacIntosh laryngoscope assistance in anesthetized and intubated patients. METHODS: Ninety-six ASA I or II patients, aged 18-70 years were recruited and randomized into two groups using either technique. The time taken from insertion of the nasogastric tube from the nostril until the calculated length of tube had been inserted was recorded. The success rate of nasogastric tube insertion was evaluated in terms of successful insertion in the first attempt. Complications associated with the insertion techniques were recorded. RESULTS: The results showed success rates of 74.5% in the GlideScope™ Group as compared to 58.3% in the MacIntosh Group (p=0.10). For the failed attempts, the nasogastric tube was successfully inserted in all cases using rescue techniques. The duration taken in the first attempt for both techniques was not statistically significant; Group A was 17.2±9.3s as compared to Group B, with a duration of 18.9±13.0s (p=0.57). A total of 33 patients developed complications during insertion of the nasogastric tube, 39.4% in Group A and 60.6% in Group B (p=0.15). The most common complications, which occurred, were coiling, followed by bleeding and kinking. CONCLUSION: This study showed that using the GlideScope™ to facilitate nasogastric tube insertion was comparable to the use of the MacIntosh laryngoscope in terms of successful rate of insertion and complications.

Protective effect of early placement of nasogastric tube with solid dilator on tissue damage and stricture formation after caustic esophageal burns in rabbits.

BACKGROUND: The ingestion of caustic substances remains an important public health issue worldwide. Children represent 80% of the ingestion injury population globally. Accidental alkaline material accounts for most caustic ingestions. There is no conclusive evidence of tissue damage and stricture protection of a nasogastric-tube with a solid dilator in the literature, therefore it was hypothesized that early intraesophageal tube placement does not cause additional histopathologic damage and prevents strictures. METHODS: An exploratory study on experimental caustic esophageal burns in a rabbit model was designed. In the treated group a silicone tube was placed immediately after causing the burns, while the untreated group followed the natural course of the burn. On the twenty-secondday, an esophagectomy was performed on all animals for microscopic (Histopathologic Damage Score and Stenosis Index) and macroscopic analysis. RESULTS: Forty animals were randomly divided into two groups. The Histopathologic Damage Score was 3.7±1.1 in the treated group versus 3.9±1.2 in the untreated group (p=.9690). The Stenosis Index was 0.6±0.1 in treated rabbits versus 2.3±0.2 in untreated (p<.0001). CONCLUSION: The early placement of an intraesophageal tube with solid dilator prevents stenosis formation and does not produce greater tissue damage.

Variation in feeding practices following the Norwood procedure.

OBJECTIVES: To assess variation in feeding practice at hospital discharge after the Norwood procedure, factors associated with tube feeding, and associations among site, feeding mode, and growth before stage II. STUDY DESIGN: From May 2005 to July 2008, 555 subjects from 15 centers were enrolled in the Pediatric Heart Network Single Ventricle Reconstruction Trial; 432 survivors with feeding data at hospital discharge after the Norwood procedure were analyzed. RESULTS: Demographic and clinical variables were compared among 4 feeding modes: oral only (n = 140), oral/tube (n = 195), nasogastric tube (N-tube) only (n = 40), and gastrostomy tube (G-tube) only (n = 57). There was significant variation in feeding mode among sites (oral only 0%-81% and G-tube only 0%-56%, P < .01). After adjusting for site, multivariable modeling showed G-tube feeding at discharge was associated with longer hospitalization, and N-tube feeding was associated with greater number of discharge medications (R(2) = 0.65, P < .01). After adjusting for site, mean pre-stage II weight-for-age z-score was significantly higher in the oral-only group (-1.4) vs the N-tube-only (-2.2) and G-tube-only (-2.1) groups (P = .04 and .02, respectively). CONCLUSIONS: Feeding mode at hospital discharge after the Norwood procedure varied among sites. Prolonged hospitalization and greater number of medications at the time of discharge were associated with tube feeding. Infants exclusively fed orally had a higher weight-for-age z score pre-stage II than those fed exclusively by tube. Exploring strategies to prevent morbidities and promote oral feeding in this highest risk population is warranted.

Enteral fluid therapy through nasogastric tube in rumen cannulated goats / Fluidoterapia enteral por via nasogástrica em cabras fistuladas no rúmen

This paper reports the effects of fluid therapy in goats through nasogastric route with an electrolyte solution composed by concentrations of sodium, potassium and chloride similar to goat plasma (140mmol/L of Na+, 4.5mmol/L of K+, 110mmol/L of Cl-). Four Alpine Chamoisee goats, two of them with evident leakage of the rumen cannulas, were used in a crossover experimental design of two periods and two groups. In one group the two goats were submitted to a treatment protocol to induce dehydration before the fluid therapy, whereas the other group was not. Fluid therapy consisted supplying 10mL/kg/h of the electrolyte solution during 8 hours. No signs of discomfort or stress were observed. The dehydration model employed caused a mild dehydration indicated by decrease in feces humidity, body weight and abdominal circumference, and increase in plasma total solids concentration. During fluid therapy globular volume and plasma total solids decreased, whereas % body weight and abdominal circumference increased. No signs of hyperhydration were observed and serum electrolytes (Na+, Cl-, K+) presented no significant alterations in both groups. Fluid therapy proposed in this study was efficient to treat dehydration, even for rumen cannulated animals with evident leakage, and can be administrated safely with no electrolyte imbalance.

Este estudo relata os efeitos da fluidoterapia em cabras que receberam, por via nasogástrica, uma solução eletrolítica com concentrações de sódio, potássio e cloreto similares às verificadas no plasma de caprinos (140mmol/L of Na+, 4.5mmol/L of K+, 110mmol/L of Cl-). Foram utilizadas quatro cabras da raça Parda Alpina, sendo duas com cânulas ruminais apresentando vazamento evidente, em um delineamento experimental crossover com dois períodos e dois grupos. Em um grupo, as cabras eram submetidas a um protocolo terapêutico para induzir a desidratação antes da fluidoterapia enquanto o outro grupo não passava por este protocolo. A fluidoterapia consistia em fornecer 10mL/kg/h da solução eletrolítica durante 8 horas. Não foi observado nenhum sinal de desconforto ou estresse. O protocolo para induzir a desidratação ocasionou desidratação moderada indicada pela diminuição da umidade das fezes, peso corporal e circunferência abdominal e aumento da concentração de sólidos totais no plasma. Durante a fluidoterapia o volume globular e a concentração de sólidos totais no plasma diminuiram, enquanto o peso vivo e a circunferência abdominal aumentaram. Não foram observados sinais de hiper-hidratação e dos eletrólitos (Na+, K+, Cl-) em ambos os grupos. A fluidoterapia proposta neste trabalho foi eficiente em tratar a desidratação, inclusive dos animais fistulados apresentando evidente extravasamento de líquido ruminal, e pode ser administrada com segurança, sem a ocorrência de desequilíbrios eletrolíticos.

Enteral fluid therapy through nasogastric tube in rumen cannulated goats / Fluidoterapia enteral por via nasogástrica em cabras fistuladas no rúmen

This paper reports the effects of fluid therapy in goats through nasogastric route with an electrolyte solution composed by concentrations of sodium, potassium and chloride similar to goat plasma (140mmol/L of Na+, 4.5mmol/L of K+, 110mmol/L of Cl-). Four Alpine Chamoisee goats, two of them with evident leakage of the rumen cannulas, were used in a crossover experimental design of two periods and two groups. In one group the two goats were submitted to a treatment protocol to induce dehydration before the fluid therapy, whereas the other group was not. Fluid therapy consisted supplying 10mL/kg/h of the electrolyte solution during 8 hours. No signs of discomfort or stress were observed. The dehydration model employed caused a mild dehydration indicated by decrease in feces humidity, body weight and abdominal circumference, and increase in plasma total solids concentration. During fluid therapy globular volume and plasma total solids decreased, whereas % body weight and abdominal circumference increased. No signs of hyperhydration were observed and serum electrolytes (Na+, Cl-, K+) presented no significant alterations in both groups. Fluid therapy proposed in this study was efficient to treat dehydration, even for rumen cannulated animals with evident leakage, and can be administrated safely with no electrolyte imbalance.(AU)

Este estudo relata os efeitos da fluidoterapia em cabras que receberam, por via nasogástrica, uma solução eletrolítica com concentrações de sódio, potássio e cloreto similares às verificadas no plasma de caprinos (140mmol/L of Na+, 4.5mmol/L of K+, 110mmol/L of Cl-). Foram utilizadas quatro cabras da raça Parda Alpina, sendo duas com cânulas ruminais apresentando vazamento evidente, em um delineamento experimental crossover com dois períodos e dois grupos. Em um grupo, as cabras eram submetidas a um protocolo terapêutico para induzir a desidratação antes da fluidoterapia enquanto o outro grupo não passava por este protocolo. A fluidoterapia consistia em fornecer 10mL/kg/h da solução eletrolítica durante 8 horas. Não foi observado nenhum sinal de desconforto ou estresse. O protocolo para induzir a desidratação ocasionou desidratação moderada indicada pela diminuição da umidade das fezes, peso corporal e circunferência abdominal e aumento da concentração de sólidos totais no plasma. Durante a fluidoterapia o volume globular e a concentração de sólidos totais no plasma diminuiram, enquanto o peso vivo e a circunferência abdominal aumentaram. Não foram observados sinais de hiper-hidratação e dos eletrólitos (Na+, K+, Cl-) em ambos os grupos. A fluidoterapia proposta neste trabalho foi eficiente em tratar a desidratação, inclusive dos animais fistulados apresentando evidente extravasamento de líquido ruminal, e pode ser administrada com segurança, sem a ocorrência de desequilíbrios eletrolíticos.(AU)

Estenose esofágica por uso de sonda nasogástrica: reflexão sobre o uso indiscriminado / Esophageal strictures after use of nasogastric tube: a reflection on the indiscriminate use

RACIONAL: A sonda nasogástrica é frequentemente empregada por clínicos e cirurgiões para diversos fins. No entanto, são descritas complicações de seu uso, sendo a estenose esofágica a mais grave, com grande morbidade, passível de prevenção e tratamento eficazes. OBJETIVO: Analisar o perfil clínico-epidemiológico, o tratamento e seus resultados, nos pacientes com esta complicação. MÉTODOS: Análise retrospectiva de 26 pacientes que apresentavam registros completos de idade, sexo, etiologia e duração da sondagem gástrica, co-morbidades e operações prévias, bem como do tratamento empregado e evolução, precoce e tardia, e classificados de acordo com a escala de resultados de Karnofsky, após seguimento médio de 28 meses. RESULTADOS: A maioria eram homens (76,9 por cento), com idade média de 47 anos e tempo médio de sondagem nasogástrica de 19 dias, sendo que 69,2 por cento eram pacientes cirúrgicos e apenas 26,9 por cento apresentavam doença do refluxo gastroesofágico. Todos foram tratados com dilatações esofágicas auxiliado por endoscopia digestiva e 61,5 por cento foram submetidos a tratamento cirúrgico. Os resultados precoces foram excelentes em 46,2 por cento, bons em 34,6 por cento e regulares em 19,2 por cento. Os resultados tardios foram excelentes em 42,4 por cento, bons em 30,7 por cento e regulares em 26,9 por cento. CONCLUSÕES: O uso da sonda nasogástrica deve ser criterioso e restrito a casos selecionados, o que previne a ocorrência de estenose esofágica, que, quando presente, pode ser tratada de maneira eficaz através de dilatações do esôfago, com ou sem operação associada, a depender de cada caso.

BACKGROUND: The nasogastric tube is often used by clinicians and surgeons for various purposes. However, complications are described with its use, and more severe esophageal stenosis with high morbidity rates, have effective prevention and treatment. AIM: To analyze the clinical, epidemiology, treatment and outcomes of patients with this complication. METHODS: Retrospective analysis of 26 patients who had complete records of age, gender, etiology and duration of gastric nasogastric tube, co-morbidities and previous surgery as well as the treatment evolution, early and late, and classified according to the scale of Karnofsky after mean follow-up of 28 months. RESULTS: The majority were men (76.9 percent), mean age 47 years and mean duration of nasogastric tube of 19 days; 69.2 percent were surgical patients and only 26.9 percent had gastro-esophageal reflux disease. All were treated with esophageal dilatation aided by endoscopy and 61.5 percent underwent surgical treatment. The early results were excellent in 46.2 percent, good in 34.6 percent and 19.2 percent regular. Late results were excellent in 42.4 percent, good in 30.7 percent and 26.9 percent regular. CONCLUSIONS: The use of nasogastric tube should be restricted to selected cases, preventing the occurrence of esophageal stricture; when present, it can be effectively treated using esophageal dilation, with or without associated operation.

Early removal of nasogastric tube is beneficial for patients undergoing radical cystectomy with urinary diversion

PURPOSE: Examine the beneficial effect of early nasogastric tube (NGT) removal in patients undergoing radical cystectomy with urinary diversion. PATIENTS AND METHODS: 43 consecutive patients underwent radical cystectomy with urinary diversion and were randomized into 2 groups. In the intervention group (n = 22), the NGT was removed 12 hours after the operation. Comparatively, in the control group (n = 21), the NGT remained in place until the appearance of the first flatus. The appearance of ileus, patient ambulation, time to regular diet, and hospital discharge of the two patient groups were assessed. Patient discomfort due to the NGT was also recorded. RESULTS: The 2 groups showed statistical homogeneity of their baseline characteristics. Two patients (9.09 percent) from the intervention and 3 patients (14.3 percent) from the control group developed postoperative ileus and were treated conservatively. No significant differences in intraoperative, postoperative, bowel outcomes or other complications were found between the two groups. All patients preferred the NGT to be removed first in comparison to their other co-existing drains. CONCLUSIONS: This is the first randomized, prospective study, to our knowledge, to assess early NGT removal after radical cystectomy. We advocate early removal, independently of the selected type of urinary diversion, since it is not correlated with ileus and is advantageous in terms of patient comfort and earlier ambulation.

Hidratação enteral em bovinos: avaliação de soluções eletrolíticas isotônicas administradas por sonda nasogástrica em fluxo contínuo / Enteral fluid therapy in cattle: evaluation of isotonic electrolyte solutions administered via nasogastric tube on continuous flow

Foram avaliados os efeitos de soluções eletrolíticas isotônicas administradas via sonda nasogástrica de pequeno calibre e fluxo contínuo sobre o hematócrito, proteína total, albumina, sódio, potássio, cloreto, magnésio total, uréia, creatinina, glicose e lactato de bovinos desidratados experimentalmente. Seis bovinos adultos, mestiços, dois machos e quatro fêmeas foram avaliados. A hidratação enteral foi administrada na dose de 15mL kg-1 h-1 durante 12 horas. Os animais foram separados em dois tratamentos num delineamento experimental crossover e submetidos a cada um dos seguintes tratamentos: SEGlic: NaCl 4g, KCl 1g, NaHCO3 4g, dextrose 5g em 1.000mL de água; SEProp: NaCl 8g, KCl 0,5g, CaCl2 0,5g, propilenoglicol 15mL em 1.000mL de água. Após a administração das soluções eletrolíticas, ocorreu expansão da volemia, em ambos os tratamentos, ocasionando diminuição do hematócrito e proteína total. A SEGli ocasionou o aparecimento de hipernatremia e aumento do lactato plasmático. Por sua vez, a SEProp aumentou a taxa de glicose plasmática, enquanto os demais parâmetros avaliados permaneceram na faixa de referência.

This study evaluated the effects of isotonic electrolyte solutions administered via small-bore nasogastric intubation on a continuous flow rate on the hematocrit, total protein, albumin, sodium, potassium, chloride, total magnesium, urea, creatinine, glucose and lactate in cattle experimentally dehydrated. Six crossbred adult cattle, two males and four females were used for the study. Enteral fluid therapy was performed by using 15mL kg-1 h-1 for 12 hours. The animals were divided in two treatments in a "crossover" experimental design and subjected to the following treatments: SEGlic: 4g NaCl, 1g KCl, 4g NaHCO3, 5g dextrose in 1.000mL of water; SEProp: 8g NaCl, 0.5g KCl, 0.5g CaCl2, 15mL propylene glycol in 1.000mL of water. Both treatments demonstrated expansion of blood volume, reduction of hematocrit and total protein. In the SEGlic treatment, hypernatremia and increase of lactate were observed. On the other hand, the SEProp treatment caused an increase in the level of plasma glucose, while the other parameters remained within the reference values.