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S K Pingleton

Publications and source records attributed to S K Pingleton.

At least 19 recordsLinked to original sources
PubMed1996

Pulmonary medicine.

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Adrenergic beta-Agonists↗
PubMed1996

Acute respiratory failure in chronic obstructive pulmonary disease.

Clinically significant chronic obstructive pulmonary disease is a common and important disorder in the United States. As many as 15 million individuals suffer from chronic obstructive pulmonary disease, many of whom have disease requiring hospital or ICU admission. Acute respiratory failure in patients with chronic obstructive pulmonary disease is one of the most common causes of admission to the ICU for this patient population. In this article I address common issues regarding diagnosis and management of acute respiratory failure in chronic obstructive pulmonary disease. Acute respiratory failure will be defined as well as the common and unusual etiologies of acute respiratory failure. Pharmacologic and nonpharmacologic treatment will be addressed, especially the ventilatory treatment of the intubated patient with chronic obstructive pulmonary disease. Special attention has been made to included the most recent investigations regarding diagnosis and treatment of the patient with chronic obstructive pulmonary disease and respiratory failure.

Acute Disease↗
PubMed1996

Enteral nutrition in patients with respiratory disease.

Nutritional assessment and management is an important therapeutic modality in patients with respiratory disease. Malnutrition adversely affects respiratory function. Nutritional therapy for the spontaneously breathing patient should include an appropriate diet plus the consideration of nutritional supplements. Complete nutritional support should be undertaken with enteral nutrition in critically ill patients with respiratory failure. Nutritional complications occur. Overfeeding can lead to nutritionally associated hypercapnia.

Enteral Nutrition↗
PubMed1996

Intermittent enteral feeding in mechanically ventilated patients. The effect on gastric pH and gastric cultures.

OBJECTIVE: To evaluate the effect of intermittent (16 h/d) enteral feeding (IEF) on gastric pH and gastric microbial growth in mechanically ventilated patients. DESIGN: Prospective, case-controlled study. SETTING: Medical ICU and infectious disease research laboratory in a university hospital. PATIENT POPULATION: Thirteen mechanically ventilated patients receiving continuous enteral feeding (CEF). METHODS: Gastric pH and quantitative gastric cultures were obtained while patients received CEF. Each patient's feeding schedule was changed to IEF. Daily gastric pH and quantitative gastric cultures were obtained for 5 consecutive days. RESULTS: Gastric microbial growth was found in 85% (11/13) of patients receiving CEF. Implementation of IEF did not clear gastric microbial growth, as only one patient subsequently reverted to negative culture. Similar gastric microbial growth continued in 90% (10/11) of patients after institution of IEF. Gastric pH did not decrease with the administration of IEF (gastric pH with IEF, 3.8 +/- 0.6 vs 4.7 +/- 0.5 with CEF (not significant [NS]). The amount of microbial growth was also unchanged with IEF (total growth with IEF, 7.8 x 10(5) +/- 5.2 x 10(5) cfu/mL vs 8.7 x 10(5) +/- 4.6 x 10(5) cfu/mL with CEF) (NS). Thirty-eight percent (5/13) of patients developed new Gram-negative rod growth in gastric cultures while receiving IEF. Gram-negative rod isolates increased from 25% of total isolates (CEF) to 40% (IEF). CONCLUSION: Our preliminary data suggest gastric pH was not lowered and existing microbial growth was not cleared in ventilated patients receiving IEF after previously receiving CEF. Further controlled study in a larger group of patients is necessary to determine whether IEF is of benefit in decreasing gastric colonization and nosocomial pneumonia.

Adult↗
PubMed1995

Pulmonary and critical care medicine.

Asthma mortality has increased not only in the United States but also across the world. Recent studies confirm the benefit of inhaled steroids compared with beta-agonists. Sepsis is now defined as the presence of SIRS with a confirmed infectious process.

Critical Care↗
PubMed1994

Gastroesophageal reflux with nasogastric tubes. Effect of nasogastric tube size.

Pulmonary aspiration of gastric contents results initially from reflux of stomach contents into the esophagus. Small-bore enteral feeding tubes are thought to result in less pulmonary aspiration and less reflux. We prospectively investigated the effect of nasogastric tube size upon gastroesophageal (GE) reflux in normal volunteers in a randomized crossover trial. Reflux was assessed by gastroesophageal scintiscanning, a radioisotopic technique that detects and quantitates GE reflux. A total of 11 subjects were studied three times: control, no nasogastric tube, small-bore (8F) nasogastric tube, and large-bore (14F) nasogastric tube. Reflux was assessed in each subject under each experimental condition by provocative testing in which abdominal pressure was increased from 0 to 100 mm Hg by 20-mm Hg increments with an abdominal pressure device. GE reflux indices were calculated for each measurement and the groups compared. A positive indicator of reflux was defined as a > or = 4% reflux index. Gastroesophageal reflux was not detected at any level of abdominal pressure regardless of the presence or size of a nasogastric tube. With maximum 100 mm Hg abdominal pressure, the reflux index was control, 1.75 +/- 0.45%; small-bore tube, 1.67 +/- 0.28%; and large-bore tube, 1.88 +/- 0.35% (NS). The reflux index was not different between small-bore and large-bore nasogastric tubes. Our data suggest the size of a nasogastric tube is not an important determinant of GE reflux in normal subjects during short-term intubation. Large-bore tubes did not cause more reflux than small-bore tubes. The presence of a nasogastric tube did not cause reflux in normal subjects. These data suggest that factors other than the size of nasogastric tube are more important in GE reflux in normal subjects.

Abdomen↗
PubMed1993

The effect of antibiotic therapy on recovery of intracellular bacteria from bronchoalveolar lavage in suspected ventilator-associated nosocomial pneumonia.

Intracellular bacteria (ICB) within recovered cells (> 7 percent) obtained via bronchoalveolar lavage (BAL) have been described as predictive of subsequent positive quantitative protected specimen brush (PSB) cultures in patients not receiving antibiotics. To determine the effect of prior or current antibiotic therapy on ICB relative to subsequent PSB culture, we prospectively evaluated 49 consecutive episodes of clinically suspected ventilator-associated pneumonia in 36 patients. Three patient groups were defined based on antibiotic administration: group 1 (current antibiotics), n = 31, samples obtained from patients currently receiving antibiotics; group 2 (recent antibiotics), n = 5, samples obtained from patients who received antibiotics > 48 h but < 72 h prior to sampling; and group 3 (no antibiotics), n = 13, samples from patients receiving no previous antibiotics within 7 days prior to sampling. Overall, PSB cultures (> or = 10(3) cfu/ml) were positive in 14 of 49 (29 percent) samples. In group 1, 2 of 31 (6 percent) samples were positive while 5 of 5 (100 percent) samples in group 2, and 7 of 13 (54 percent) in group 3 were positive. The presence or absence of ICB accurately predicted both positive and negative PSB cultures in 43 of 49 episodes. Of 43 correct predictions, 34 were negative predictions (negative ICB, negative PSB culture). The vast majority of these (29) were obtained from group 1, patients currently receiving antibiotics. In contrast, of nine positive predictions (+ICB, +PSB) virtually all (seven) occurred in group 3, patients receiving no antibiotics. In group 3, 13 of 13 PSB cultures were accurately predicted, either positive or negative, by the presence or absence of ICB. Of seven positive PSB cultures in groups 1 and 2, only 2 (28 percent) were accurately predicted by ICB. From both samples, the cultured organism was resistant to all administered antibiotics. These data suggest both prior and current antibiotic therapy reduces recovery of ICB from BAL and reduces predictive accuracy of ICB for subsequent positive PSB cultures. However, negative prediction by ICB for subsequent negative PSB cultures was good. In contrast, ICB obtained from patients not receiving antibiotics are highly predictive of subsequent PSB culture results, both positive and negative. We do not recommend BAL for evaluation of ICB in patients currently receiving antibiotics or with a recent history of antibiotic use.

Adult↗
PubMed1992

Nutritionally associated increased carbon dioxide production. Excess total calories vs high proportion of carbohydrate calories.

This study compared carbon dioxide production (VCO2) from isocaloric nutritional regimens with varying concentration of carbohydrates with VCO2 from low and high caloric nutritional regimens with constant concentrations of carbohydrates (CHO) in 20 stable mechanically ventilated patients. Ten patients (group A) received total parental nutrition in the form of three isocaloric nutritional regimens; 40 percent CHO/40 percent fat/20 percent protein, 60 percent CHO/20 percent fat/20 percent protein, and 75 percent CHO/5 percent fat/20 percent protein. The VCO2 did not change with increasing CHO proportion; 205 +/- 35 ml/min, 203 +/- 25 ml/min, and 211 +/- 35 ml/min, respectively. Ten additional patients (group B) received three nutritional regimens at 1.0, 1.5, and 2.0 times the estimated resting expenditure with a 60 percent CHO/20 percent fat/20 percent protein proportion. The VCO2 increased with increasing total calories, 181 +/- 23 ml/min, 211 +/- 38 ml/min, and 244 +/- 40 ml/min (p less than 0.05). High caloric feeding increases VCO2 in contrast to high percentage carbohydrate formulation. Thus, moderate caloric intake appears to be more important in avoiding nutritionally related increases in VCO2 in stable mechanically ventilated patients.

Aged↗
PubMed1991

Adaptation in families with a member requiring mechanical ventilation at home.

Current health care trends indicate that ventilator-dependent patients increasingly will be discharged to home after shorter hospitalizations. The purpose of this study was to determine how care givers adapt to having ventilator-dependent adults at home. Twenty families were interviewed in their homes by using an eight-question semistructured interview guide. The Roy model was used as a framework to analyze these data. Two instruments, the Family Coping Scale (F-COPES) and the Family APGAR, were administered to measure family coping and function. Patients, aged 18 to 74 years, required 24-hour (n = 9), 12- to 15-hour (n = 5), or 8- to 12-hour (n = 6) home ventilatory support and had neuromuscular or trauma-related diagnoses. Months receiving ventilation ranged from 2 to 312. Care givers, aged 20 to 74 years, were all relatives. Six care givers reported using support services outside their extended family. F-COPES scores fell within national norms whether the patient required 24-hour or less ventilation. Family APGAR results revealed satisfaction with overall family function although scores decreased over time. Interview data indicated that essential knowledge and skills are taught but additional information is desired. Both positive and negative responses to care giving were identified, with the majority of responses being concerned with role mastery, self-concept, and dependency issues. Positive themes in the interviews reflected confidence in ventilator care, satisfaction with the decision to care for their family member at home, and improved quality of life. Negative themes in the interviews reflected the burden of care giving, the dependence of the patient on the care giver, resentment, and hopelessness.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed1990

Enteral nutrition and infection in the intensive care unit.

Nutritional support of critically ill patients is important since adverse effects of malnutrition are multiple and common. Nutrition via the enteral route is often preferred over central venous or total parenteral nutrition due to its relative ease of administration, lower cost, and infrequent association with severe complication. Enteral nutrition and infection are related. Infectious complications of sepsis and nosocomial pneumonia can occur, but enteral nutrition also may be important in maintenance of normal gut structure and function, thereby decreasing bacterial translocation and the risk of systemic infection.

Cross Infection↗