Treatment and prevention of ocular motility restrictions with amniotic membrane transplantation.

We intend to investigate the indications, complications, and final results of amniotic membrane (AM) transplantation in ocular motility restrictions. Surgeons have tried to prevent restrictive adhesions between the extraocular muscles and surrounding tissues because they cause unpredictable results. AM transplantation wrapping extraocular musculature has been proposed as a technique with good results for this purpose. A search was carried out in Medline, Embase, Cochrane Library and Clinicaltrial, Lilac and Ibecs databases, using the indexed terms" amnion", "strabismus," "strabismus-subheading-surgery" and "ocular motility disorders." The only exclusion criteria were studies conducted in non-humans or studies with insufficient data on eye motility. No study was discarded for analysis because of language, age or methodology. This review includes 165 patients (223 eyes), with a mean follow-up of 11.49 months. The mean age was 21 years old, 47% were males and 57% were children. 14 studies conducted in humans were eligible: 4 single case, 8 case series, 1 cohort study and 1 randomized clinical trial. In the vast majority of these papers, use of AM transplantation to treat (12 out of 14 papers) or either to prevent (2 out of 14 papers) motility restrictions or restrictive strabismus secondary to muscular adhesions. All the studies except one presents very favorable results improving postsurgical eye motility. The cryopreservation method was more widely used, presenting a good safety profile with few adverse effects in the short and medium term. Significant improvement was reported in most patients after the use of amniotic membrane transplantation to treat or prevent ocular motility limitations. Very few complications or adverse effects were documented.

Early enteral nutrition in patients with hemodynamic failure following cardiac surgery.

BACKGROUND: Enteral nutrition (EN) is controversial in patients with circulatory compromise. This study assesses the feasibility and safety of EN given early after cardiac surgery in patients with hemodynamic failure. METHODS: Prospective observational study conducted in a surgical intensive care unit (ICU) of a tertiary hospital over 17 months. INCLUSION CRITERIA: Cardiac surgery patients with hemodynamic failure (dependence on 2 or more vasoactive drugs and/or mechanical circulatory support) requiring more than 24 hours of mechanical ventilation. Variables Examined: Descriptive data, daily hemodynamic data, and variables related to the efficacy and safety of EN. EN was performed according to our EN protocol. RESULTS: Of 642 patients admitted to the ICU, 37 (5.8%) met the inclusion criteria. Of these, 11 (29.7%) required mechanical circulatory support, and 25 (68.0%) met the criteria for early multiorgan dysfunction. Mortality was 13.5%. Mean EN duration was 12.3 days (95% confidence interval [CI], 9.6-15.0). The mean EN diet volume delivered/patient/d was 1199 mL (95% CI, 1118.7-1278.8), and mean EN energy delivered/patient/d was 1228.4 kcal (95% CI, 1145.8-1311). The set energy target was achieved in 15 patients (40.4%). The most common EN-related complication was constipation. No case of mesenteric ischemia was detected. CONCLUSIONS: Our findings indicate that early EN is feasible in this type of patients and not associated with serious complications. However, it is difficult to attain an appropriate energy target by EN alone. These observations point to a need for monitoring of daily energy delivery and balance, as well as careful monitoring of warning signs of intestinal ischemia.

Early enteral nutrition in adults receiving venoarterial extracorporeal membrane oxygenation: an observational case series.

BACKGROUND: Despite its benefits, early enteral nutrition (EN) is considered controversial in critically ill patients with severe hemodynamic failure. OBJECTIVE: To evaluate the tolerance and safety of early EN in a consecutive group of patients receiving venoarterial (VA) extracorporeal membrane oxygenation (ECMO) for severe hemodynamic failure. MATERIALS AND METHODS: Prospective observational study performed in a cardiac surgical intensive care unit (ICU) during a 1-year period. All adult patients receiving VA ECMO for severe hemodynamic failure unresponsive to conventional therapies were included. Nutrition support was provided during the study period following the established ICU nutrition protocol. Energy target was 25 kcal/kg, to be reached over 4 days. Nutrition tolerance was defined as the ratio of delivered nutrition to target nutrition, expressed as a percentage. Special interest was made to detect possible adverse effects attributable to EN. The authors performed a descriptive statistical analysis. RESULTS: Of 553 patients admitted in the cardiac surgical ICU during the study period, 7 were treated with ECMO. EN was the only nutrition source. More than 70% nutrition tolerance was achieved within the first week in all cases. No serious adverse events that could be attributable to EN were noted. CONCLUSION: The present study shows that, under proper medical supervision, early EN is possible and safe in patients with severe hemodynamic failure receiving VA ECMO. No serious adverse events were attributable to EN. More studies are warranted to confirm these findings.