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R Bower

Publications and source records attributed to R Bower.

23 records · Page 2Linked to original sources
PubMedDate not supplied

Intestinal placement of pH-sensing nasointestinal feeding tubes.

Intestinal access for enteral nutrition can be achieved by spontaneous intestinal nasogastric tube passage or by endoscopic, fluoroscopic, or surgical placement methods. Each of these methods has limitations that may compromise clinical utility. pH-sensing nasointestinal feeding tubes allow active placement with minimal equipment and expertise; however, this method requires an acidic gastric pH. We sought to determine whether antiulcer regimens used at our institution would preclude intestinal pH-sensing tube placement. Twenty-five patients had 25 (81%) successful intestinal placements in 31 attempts. Observed pH values and calculated pH changes were compared within and between successful and unsuccessful groups by using a Student's t test. Initial, lowest, and final pH values did not differ significantly between groups. The pH change initial-to-lowest (4.7 +/- 0.18 vs 3.6 +/- 0.59, p < .03) and lowest-to-final (5.0 +/- 0.18 vs 3.0 +/- 0.47, p < .0001) differed significantly between groups, whereas the pH change initial-to-final did not. Cost analysis of endoscopic ($782), fluoroscopic ($341 to $382), spontaneous ($167 to $212), and pH-sensing ($162) methods revealed 3% to 79% savings when the pH-sensing placement method was used. We conclude that the antiulcer therapies used in our patient population did not preclude intestinal pH-sensing tube placement. If the pH changes from initial-to-lowest and lowest-to-final were greater than 4, successful intestinal placement occurred in 91% of attempts. Finally, the method was cost-effective at our institution.

Anti-Ulcer Agents↗
PubMedDate not supplied

Association of cholecystitis and parenteral nutrition.

Total parenteral nutrition (TPN) is a well-established means of nutritional support in the critically ill patient who is unable to maintain adequate oral intake. A complication of long-term parenteral nutrition is gallbladder disease. Cholecystitis is often difficult to diagnose in patients with multisystem disease and has a dour prognosis when there is delay in diagnosis and operative treatment. An awareness of the risk factors for cholecystitis, including TPN, in the critically ill patient is the sine qua non of early diagnosis. If cholecystitis is suspected, the diagnosis may be established by ultrasonography, tomography, and scintigraphy. Immediate cholecystectomy is the treatment of choice.

Adult↗