Improvised dual lumen nasojejunal feeding tube with gastric decompression.
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ABSTRACT:
SUBMITTER: Tan JRL
PROVIDER: S-EPMC10577376 | biostudies-literature | 2023 Oct
REPOSITORIES: biostudies-literature
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Improvised dual lumen nasojejunal feeding tube with gastric decompression.
Tan Justin Ryan L JRL Tan Jose A JA Co Arsenio A Ong Evan G EG Corral Lord Byron LB
VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy 20230804 10
Video 1Improvisation of the nasojejunal tube for gastric outlet obstruction. ...[more]
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Project description:BackgroundThoracic surgery often demands separation of ventilation between the lungs. It is achieved with double-lumen tubes (DLTs), video double-lumen tubes (VDLTs) or bronchial blockers. We tested the hypothesis that intubation with the VivaSight double-lumen tube would be easier and faster than with a standard DLT.MethodsSeventy-one adult patients undergoing thoracic procedures that required general anaesthesia and one-lung ventilation (OLV) were enrolled in this randomized, prospective study. Patients were randomly assigned to procedure of intubation with a standard DLT or VDLT. The collected data included: patients' demographics, surgery information, anthropometric tests used for difficult intubation prediction, specifics of intubation procedure, tube placement, fiberoptic bronchoscopy (FOB) use, lung separation, trachea temperature, and reported complications of intubation.ResultsFor DLTs compared to video-double lumen tubes, intubation time was significantly longer (125 vs. 44 s; P<0.001), intubation graded harder (P<0.05) and FOB use was more prevalent [8 (20.5%) vs. 0; P<0.05].ConclusionsThe use of VDLTs when compared with standard-double lumen tubes offers reduced intubation time and is relatively easier. Also, the reduced need for fibreoptic bronchoscopy may improve the cost-effectiveness of VDLT use. In addition, constant visualization of the airways during the procedure allows to quickly correct or even prevent the tube malposition.Trial registrationClinicalTrials.gov Identifier: NCT04101734.
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| S-EPMC7947371 | biostudies-literature
Project description:Video Video 1 Xxx.
| S-EPMC9938360 | biostudies-literature
Project description:ObjectiveThe aim of this study was to test the hypothesis that early oral feeding (EOF) is superior to early nasojejunal nutrition (ENN) after pylorus-preserving pancreaticoduodenectomy (PPPD) in terms of delayed gastric emptying (DGE).BackgroundDGE is a common complication after PPPD. Although EOF after PPPD is recommended by several international guidelines, there is no randomized trial to support this recommendation.MethodsFrom September 2016 to December 2017, a total of 120 patients undergoing PPPD were randomized into the ENN, EOF, or saline groups at a 1:1:1 ratio (40 patients in each group). The primary endpoint was the rate of clinically relevant DGE. Secondary endpoints included overall morbidity, postoperative pancreatic fistula, post-pancreatectomy hemorrhage, abdominal infection, length of hospital stay, reoperation rate, and in-hospital mortality.ResultsThe baseline characteristics and operative parameters were comparable between the groups. The incidence of clinically relevant DGE varied significantly among the three groups (ENN, 17.5%; EOF, 10.0%; saline, 32.5%; p =0.038). The saline group had a higher clinically relevant DGE rate than the EOF group (p = 0.014). The saline group also had greater overall morbidities than the ENN and EOF groups (p = 0.041 and p = 0.006, respectively). There were no significant differences in other surgical complication rates or postoperative hospital stay. No mortality was observed in any of the groups.ConclusionsNutritional support methods were not related to DGE after PPPD. EOF was feasible and safe after PPPD, and additional ENN should not be routinely administered to patients after PPPD.Clinical trial registrationClinicalTrials.gov, identifier NCT03150615.
| S-EPMC8118637 | biostudies-literature
Project description:Intervention participants will receive enteral feeding post-operatively via a nasojejunal gastric decompression tube placed intra-operatively. This tube will allow for simultaneous enteral feeding into the jejunum and gastric drainage. It is standard practice for all patients to receive a nasogastric tube during surgery which is usually used for gastric drainage only. Feeds will commence via the nasojejunal feeding port within 24hours of surgery using a standard polymeric enteral feed which is already used frequently throughout the hospital. Enteral feeds will run at 20mL/hr (equivalent to one tablespoon every hour) over 24 hours until post-operative day 3, after which the feed rate will be reviewed for increase. Nasogastric decompression will be managed as per the surgeon/intensive care unit (ICU) policy. If the participant has tolerated the feeds, the rate will be increased to 40ml/hour on post-operative day 3, 60ml/hour on post-operative day 5 and goal rate on post-operative day 7. Compliance to the intervention will be assessed and monitored through the audit of medical notes and standard observation charts. Parameters for feeding tolerance will be assessed using gastrointestinal and biochemical indicators including abdominal distension, vomiting, bloating, abdominal pain, nausea, C-Reactive protein, white blood cells, lactate and vital signs in discussion with the surgical and ICU team. Participants will also commence parenteral nutrition (PN) (current standard practice) at the same time the enteral nutrition starts. The combination of PN and enteral nutrition will meet the participant’s nutritional requirements as determined by the dietitian. PN rates will be increased operatively as per standard practice and then decreased if the rate of enteral feeding is increa
Primary outcome(s): Feasibility of nasojejunal feeding post CRS and HIPEC. Feasibility will be defined as the ability to deliver at least 60ml/hour of enteral feeds via the NJ tube by post-operative day 6. This will be assessed using the medical record and fluid balance charts.
[Post-operative day 6.];Complications of the nasojejunal-gastric decompression tube. This outcome will be assessed using the medical records.[End of intervention]
Study Design: Purpose: Prevention; Allocation: Non-randomised trial; Masking: Open (masking not used);Assignment: Other;Type of endpoint: Efficacy
| 2473150 | ecrin-mdr-crc
Project description:BackgroundDouble lumen endotracheal tubes (DLT) are commonly used to provide single lung ventilation during thoracic surgery. A fiberoptic bronchoscope (FOB) is typically used to confirm accurate DLT placement. Accounting for initial purchase, maintenance, repair and cleaning, the use of an FOB can cost as much as $312 per procedure. The VivaSight DLT (VS-DLT) incorporates a built-in camera, which is aimed at reducing FOB use and its associated costs. In this study, we compared the rate of FOB use when intubating using either a VS-DLT or a conventional DLT (c-DLT).MethodsThis is a randomized controlled comparative study performed at a public county teaching hospital. A total of 50 patients were enrolled and randomly assigned to either a c-DLT (n=25) or a VS-DLT (n=25). The primary outcome was the rate of FOB use. Secondary outcomes included time to correct tube placement and incidence of malposition during surgery.ResultsUse of the VS-DLT required significantly less FOB use (28%) compared to use of the c-DLT (100%). While there was no difference in the ease of intubation, the time to correct tube placement was significantly faster using a VS-DLT (54 vs. 156 s, P<0.001). Additionally, the incidence of tube malposition was significantly reduced in the VS-DLT group.ConclusionsThis study demonstrated a significantly lower rate of FOB use when using a VS-DLT compared to a c-DLT. Placement of the VS-DLT was significantly quicker and malposition during surgery occurred significantly less than with the c-DLT. While intubating with a VS-DLT provides clinical benefits, it may not result in significant cost reductions when compared to a c-DLT.
| S-EPMC7711371 | biostudies-literature
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| S-EPMC10643211 | biostudies-literature
Project description:Malnutrition is an important problem following esophagectomy. A surgically placed jejunostomy secures an enteral feeding route, facilitating discharge with home-tube feeding and long-term nutritional support. However, specific complications occur, and data are lacking that support its use over other enteral feeding routes. Therefore routine jejunostomy tube feeding and discharge with home-tube feeding was evaluated, with emphasis on weight loss, length of stay and re-admissions.Consecutive patients undergoing esophagectomy for cancer, with gastric tube reconstruction and jejunostomy creation, were analyzed. Two different regimens were compared. Before January 07, 2011 patients were discharged when oral intake was sufficient, without tube feeding. After that discharge with home-tube feeding was routinely performed. Logistic regression analysis corrected for confounders.Some 236 patients were included. The median duration of tube feeding was 35 days. Reoperation for a jejunostomy-related complication was needed in 2%. The median body mass index (BMI) remained stable during tube feeding. The BMI decreased significantly after stopping tube feeding: from 25.6 (1st-3rd quartile 23.0-28.6) kg/m2 to 24.4 (22.0-27.1) kg/m2 at 30 days later [median weight loss: 3.0 (1.0-5.3) kg; 3.9% (1.5-6.3%)]. Weight loss was not affected by the duration of tube feeding duration. Routine home-tube feeding did not affect weight loss, admission time or the readmission rate.Weight loss following esophagectomy occurs once that tube feeding is stopped, independently from the time interval after esophagectomy. Moreover routine discharge with home-tube feeding does not reduce length of stay or readmissions. These findings question the value of routine jejunostomy placement and emphasize the need for further research.
| S-EPMC5538975 | biostudies-other
Project description:Introductionand importance: We reported a case of secondary spontaneous pneumothorax (SSP) in a 70-years-old male with acute exacerbation of COPD (AE COPD) managed with improvised chest tube drain (ICD).Case presentationHe presented with sudden onset breathlessness and oxygen saturation of 78%. With prolonged expiration on auscultation, he was treated as AE COPD with oxygen therapy, nebulization with albuterol/ipratropium, and injectable antibiotics and steroids. The patient was not improving with treatment on third day, and non-critical respiratory distress continued. Considering the alternative diagnosis, the chest X-ray was done which revealed right sided spontaneous pneumothorax and COPD. Due to his reluctancy to go to higher center for chest tube insertion during ongoing COVID-19 pandemic, we inserted ICD (intravenous set put in saline bottle) at our primary care. Following drainage, breathlessness improved and saturation increased. Then inpatient symptomatic treatment for COPD was continued for three more days. He was discharged on inhalers after fifth day and asked for follow up after 10 days. He came after 1 month and on repeat chest X-ray, his right sided pneumothorax resolved completely and COPD was in control with inhaled medications. There was no recurrence of pneumothorax in five months follow up.Clinical discussionICD is a safe, and an alternative option in resource limited setting. However, the guidelines recommend chest tube insertion as appropriate treatment.ConclusionThis would remind the physicians to anticipate the alternative possibility, and to re-examine those with AE COPD who are not improving as expected with oxygen and nebulization therapy.
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