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Biomedical subjects

S K Pingleton

Publications and source records attributed to S K Pingleton.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1989

Enteral nutrition as a risk factor for nosocomial pneumonia.

Nutritional support of critically ill patients in the intensive care unit is important, since adverse effects of malnutrition are multiple and common. Nutrition via the enteral or gastrointestinal tract is often preferred over central venous or total parenteral nutrition as the initial choice of nutritional therapy due to its relative ease of administration, lower cost and infrequent association with severe complications. Recent data suggest that nosocomial pneumonia, a severe and ominous complication of critical illness, is related to gastric colonization secondary to alkalinization of stomach contents by antacids and H2-antagonists. Nosocomial pneumonia may also be related to enteral nutrition. Gastric microbial growth increases after the onset of enteral nutrition. Gastric organisms can be transmitted to the trachea and result in tracheal colonization and nosocomial pneumonia. Gastric to tracheal transmission of organisms is probably related to pulmonary aspiration. Several factors are important in pulmonary aspiration, including nasogastric tube size, method of nutrient delivery, patient position, and gastric and intestinal motility. Enteral nutrition must be considered in both the evaluation of mechanisms of nosocomial pneumonia and the strategies of prophylaxis.

Bacterial Infections↗
PubMed1989

Nonhemorrhagic gastrointestinal complications in acute respiratory failure.

While GI hemorrhage is a recognized complication of critical illness, nonhemorrhagic GI complications are less well described. We studied prospectively the incidence and predisposing factors of nonhemorrhagic GI complications in 124 acute respiratory failure (ARF) patients over a 13-month period. Diarrhea occurred in 51% (63/124), decreased bowel sounds in 50% (62/124), and abdominal distention in 46% (57/124). Patients with pneumonia as the etiology of respirator failure had the highest number of different complications (five per ICU stay). Ileus was found more frequently in patients with a past history of liver disease (p less than .03). Antacid administration was associated with a significant increase in diarrhea (p less than .01), as were the combined treatments of antacids and cimetidine (p less than .02). Patients with ARF have a high incidence of nonhemorrhagic GI complications. Diarrhea is the most common complication and occurs more frequently in patients who receive antacids.

Acute Disease↗
PubMed1988

Is routine assessment of arterial oxygen saturation in pulmonary outpatients indicated?

Pulse oximetry was used in 1,675 pulmonary outpatient visits to determine whether routine assessment of arterial oxygen saturation was indicated in detecting unanticipated severe desaturation. An SaO2 less than 85 percent was found in only 18 visits (1.1 percent). Changes in symptoms, pulmonary function or both which alerted the clinician to a possible problem were identified in 16 of those 18 visits. Only two episodes of desaturation were not identified by history or simple spirometric evaluation. Routine pulse oximetry does not appear to be of value in screening large numbers of pulmonary outpatients for unexpected desaturation, since it is uncommon in the absence of associated clinical findings.

Aged↗
PubMed1988

Nutritional support in the mechanically ventilated patient.

In summary, nutritional management of the intubated patient requires several decision steps. Nutritional support should be strongly considered if the patient has evidence of malnutrition by nutritional assessment or has a high likelihood of becoming malnourished by virtue of a severe, prolonged critical illness. Nutrition can be administered enterally if good gut function exists or parenterally in patients unable to tolerate enteral feeding. Nutritional goals in the intensive care unit include maintenance of body weight and lean body mass. Proper nutritional therapy includes assessment of adequate caloric requirements as well as appropriate protein, carbohydrate, and fat composition of the nutritional support. Monitoring the efficacy of nutritional therapy includes evaluating nitrogen balance. Complications of both enteral and parenteral therapy exist. Nutritional therapy is but one link in the chain of therapeutic endeavors given a critically ill patient but, as with all other treatment modalities, requires knowledge of basic fundamentals.

Enteral Nutrition↗
PubMed1987

Recognition and management of upper gastrointestinal hemorrhage.

Upper gastrointestinal hemorrhage is a frequent and severe problem in the intensive care unit. Such bleeding results from diverse gastroenterologic causes. Diagnosis and assessment of the severity of bleeding is accomplished primarily through the physical examination; endoscopy is the most sensitive means of establishing a specific site of hemorrhage. Medical management of gastrointestinal hemorrhage includes treatment with the histamine (H2)-receptor antagonists, antacids, or both. Recent studies suggest that continuous infusion of H2-receptor antagonists may be more efficacious than fixed-bolus dosing in prophylaxis of upper gastrointestinal bleeding. It is not known as yet if the continuous infusion regimen will be effective in stopping gastrointestinal bleeding that has already begun.

Gastrointestinal Hemorrhage↗
PubMed1987

Nutritional management in acute respiratory failure.

Nutrition in the intensive care unit is receiving increased attention. Patients with acute respiratory failure from primary lung disease are often initially malnourished, or become malnourished secondary to increased metabolic demands or inadequate nutritional support. Adverse effects of malnutrition on lung function include decreased respiratory muscle function, decreased ventilatory drive, and altered lung defense mechanisms. Nutritional support should be strongly considered if the patient has evidence of malnutrition by nutritional assessment or has a high likelihood of becoming malnourished by virtue of severe, prolonged critical illness. General nutritional goals in the intensive care unit include maintenance of body weight and lean body mass. Proper nutritional therapy includes assessment of adequate caloric requirements and appropriate protein, carbohydrate, and fat composition of the nutritional support. Nutritional therapy should be closely monitored with body weight and nitrogen-balance measurements.

Acute Disease↗
PubMed1987

Nocturnal positive pressure ventilation via nasal mask.

Five patients with chronic respiratory failure from neuromuscular disease and symptomatic worsening nocturnal hypoventilation were treated with nocturnal ventilation. Home ventilation at night was provided by a volume-cycled positive pressure ventilator attached to a nasal mask originally designed to administer nasal continuous positive airway pressure (CPAP) for obstructive sleep apnea. The device was well tolerated. Symptoms of headache, insomnia/somnolence, and impaired intellectual capacity rapidly disappeared with nocturnal ventilatory support. Daytime arterial PO2 and PCO2 improved after therapy. There are several advantages over commonly used, negative pressure devices for nocturnal ventilation. These include patient synchronization of tidal volume, ease of application, less cumbersome apparatus, more nocturnal patient mobility, and absence of production of upper airway obstruction.

Humans↗
PubMed1987

Breathing pattern abnormalities and arterial oxygen desaturation during sleep in the congestive heart failure syndrome. Improvement following medical therapy.

We observed breathing pattern abnormalities and arterial oxygen desaturation in patients with stable congestive heart failure during overnight polysomnography. To determine whether congestive heart failure was the reason for these abnormalities, we then studied six additional patients before and after treatment of heart failure. Breathing was more abnormal (153 +/- 87 episodes/night) during decompensation of heart failure and improved with medical therapy (72 +/- 100 episodes/night) (p less than 0.05). Abnormal breathing patterns resolved in three patients, improved in two, and were unchanged in one patient after therapy. Allographic cardiac transplantation in one patient whose sleep study remained unchanged after medical therapy was associated with resolution of breathing pattern abnormalities and severe desaturation during sleep. Therapy-related improvement in nocturnal respiratory events suggests congestive heart failure is a contributing factor for breathing abnormalities and arterial oxygen desaturation during sleep.

Aged↗
PubMed1986

Enteral nutrition in patients receiving mechanical ventilation. Multiple sources of tracheal colonization include the stomach.

Nutritional therapy of patients receiving mechanical ventilation includes enteral feeding. To determine the frequency of gastric microbial colonization in patients receiving enteral nutrition, 18 patients with acute respiratory failure receiving ventilation were studied. Multiple sources of tracheal colonization were then evaluated to determine the frequency of tracheal transmission of gastric flora and the relationship of gastric colonization and transmission to nosocomial respiratory infection. The stomach was colonized in every patient who received enteral feeding. Tracheal colonization occurred in 89 percent (16 of 18) of patients. In 12 of these 16 patients, 14 organisms colonized the trachea after transmission from the stomach and/or oropharynx. Thirty-six percent (five of 14) of organisms transmitted to the trachea originated from the stomach, whereas another 36 percent (five of 14) were first recovered from the oropharynx. Four tracheally transmitted organisms were first recovered simultaneously from the stomach and oropharynx. Nosocomial respiratory infection developed in 11 patients (63 percent). Three infections occurred during the six-day study period, one of which was associated with transmission of a gastric organism. Multiple sources of tracheal colonization occur in patients receiving enteral nutrition. The stomach is an important source of tracheal colonization. Enteral nutrition can be associated with gastric flora colonizing the trachea and causing nosocomial respiratory infection.

Acute Disease↗
PubMed1985

Prolongation of gastric emptying by aerosolized atropine.

Aerosolized atropine causes anticholinergic side effects. We evaluated gastroparesis, a previously unreported side effect of inhaled atropine, in a double-blind, placebo-controlled, crossover study. Six young asthmatics received atropine (0.05 mg/kg) or placebo at 4-h intervals for 3 dosages, on 2 separate days at least 1 wk apart. Subjective complaints, pulse, visual accommodation, and citric-acid-stimulated salivary flow were recorded 30 min after each dose on each study day. A radionuclide (99mTc) study of gastric emptying time was done 30 min after the final dose on each study day. Atropine prolonged mean gastric half emptying time (112 +/- 59 min) compared with placebo (65 +/- 34 min) (p less than 0.05). However, gastric emptying after atropine was in the abnormal range in only 2 patients. Stimulated salivary flow decreased after atropine (1.97 +/- 1.7 g saliva) compared with flow after placebo (4.1 +/- 1.2 g) (p less than 0.05). No changes in visual accommodation or pulse rate were seen. Dry mouth and decreased salivation correlated with delayed gastric emptying (r = 0.76, p less than 0.05). Anticholinergic side effects of aerosolized atropine include prolonged gastric emptying in some patients. Gastroparesis after inhaled atropine is suggested by the symptom of dry mouth.

Adult↗
PubMed1985

Hypercapnia during weaning. A complication of nutritional support.

Excess carbohydrate calories in total parenteral nutrition (TPN) solutions can precipitate acute hypercapnic respiratory failure in patients with chronic lung disease secondary to increased carbon dioxide (CO2) production. Two young patients recovering from the adult respiratory distress syndrome experienced hypercapnia during weaning as a result of nutritionally related increased CO2 production. As carbohydrate calories were decreased, CO2 production diminished and hypercapnia resolved. Hypercapnia as a complication of nutritional support during weaning can occur in patients without chronic lung disease and is corrected by decreasing carbohydrate calories.

Adult↗
PubMed1983

Gastrointestinal hemorrhage.

Two types of upper gastrointestinal bleeding can be differentiated in the critical care setting: bleeding caused by a gastroenterologic disorder or bleeding that develops as a complication of a nongastroenterologic critical illness. A clinical approach to upper gastrointestinal bleeding is presented. Lower gastrointestinal hemorrhage and the diagnosis of gastrointestinal bleeding in infants and children are also briefly discussed.

Adolescent↗
PubMed1983

Complications of acute respiratory failure.

Acute respiratory failure is frequently fatal. Attempts to decrease mortality must include attention to pulmonary and extrapulmonary complications. Pulmonary complications include pulmonary emboli, barotrauma, fibrosis, and pneumonia. Swan-Ganz catheters, tracheal intubation, and mechanical ventilation can also result in pulmonary complications. Extra-pulmonary complications such as gastrointestinal hemorrhage, renal failure, infection, and thrombocytopenia may increase mortality. Early diagnosis, aggressive treatment, and prophylaxis of complications should increase survival.

Acute Disease↗