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At least 19 recordsLinked to original sources
PubMed1992

Routine omission of nasogastric intubation after gastrointestinal surgery.

The need for routine nasogastric-tube decompression after gastrointestinal surgery has been challenged repeatedly for several years. To determine whether nasogastric intubation can be omitted routinely, 101 consecutive patients who underwent gastrointestinal surgery were managed prospectively without nasogastric tubes. Excluded were patients with complete bowel obstruction and those who required prolonged endotracheal intubation. These patients were compared with 101 retrospective controls who had nasogastric decompression routinely. There were four protocol violations in the prospective group (nasogastric tubes were left in place postoperatively) and one in the retrospective group (no nasogastric tube postoperatively), leaving 97 and 100 patients, respectively, for follow-up. The mean duration of hospitalization in comparable patients was 10.6 days in patients without decompression and 11.9 days in those with routine decompression. Subsequent nasogastric-tube insertion was required in nine patients who did not undergo routine decompression, compared with two patients who had routine decompression. There were no statistically significant differences in the rates of anastomotic leaks, wound disruptions and pulmonary or other complications between the two groups. The authors conclude that nasogastric decompression can be safely omitted as a routine part of postoperative care after gastrointestinal surgery.

Digestive System Surgical Procedures↗
PubMed1976

Esophageal perforation in the neonate. A review of the literature.

The clinical and roentgenographic findings in traumatic esophageal perforation in the newborn are specific enough to enable a diagnosis to be made rapidly. A case of this entity is discussed and the literature on this subject is reviewed. This case demonstrates that the diagnosis can be strongly suspected from the findings on the chest roentgenogram and confirmed by performing an esophagram.

Diagnosis, Differential↗
PubMed1978

Tracheoesophageal fistula caused by cuffed tracheal tube. Successful treatment by tracheal resection and primary repair with four-year follow-up.

A tracheoesophageal fistula secondard to prolonged nasogastric intubation and ventilatory assistance via a cuffed tracheostomy tube developed in a 27-year-old woman who had sustained a traumatic injury. The fistula grew progressively larger despite removal of the tubes, thus demonstrating the inherent poor prognosis associated with the untreated lesion. Since the cuff necessarily damages the trachea circumferentially at the same level, closure of the fistula and circumferential excision and reconstruction of the damaged tracheal wall were performed with an excellent result up to four years after the repair. This would be the preferred procedure when the patient can be weaned off the respirator and when the general condition and the size of the fistula allow such a definitive one-stage approach.

Abortion, Spontaneous↗
PubMed1992

The use of endotracheal tubes to assist in manipulation of esophageal strictures, in elongation of the esophagus in esophageal atresia, and in gastrojejunal feeding tube placement.

Because of the special qualities of a PVC endotracheal tube (smooth, soft, pliable but still with a patent lumen), it serves very well for the intubation of the esophagus or the duodenum through an established gastrostomy. In this article the use of endotracheal tubes in different manipulations of the esophagus and gastroduodenum is described.

Dilatation↗
PubMed1992

Occult fever in surgical intensive care unit patients is seldom caused by sinusitis.

Febrile intensive care unit (ICU) patients were evaluated prospectively for sinusitis. Of 598 admissions, 26 patients with transnasal cannulas, ICU stays over 48 hours, and occult fevers were identified. These 26 underwent physical examinations and sinus computed tomographic (CT) scans. Maxillary centeses and cultures were done in patients with CT abnormalities. Patients with positive scans had nasal tubes removed and received decongestants. Scans were abnormal in 19 (73%). All patients with major CT changes had positive maxillary taps. Most infections were polymicrobial; enteric bacilli were common. Fever resolved with nonoperative care in 18 (95%) patients; in only 1 patient was fever primarily from sinusitis. Sinus CT scans are often abnormal in ICU patients with occult fevers and transnasal cannulas. Pneumatic otoscopy can serve as a screening tool. Most patients respond to nonoperative management. Remote infections are often present. Although radiographic nosocomial ICU sinusitis is common, it is seldom the sole source of fever or the proximate cause of significant morbidity.

Bacterial Infections↗
PubMed1992

Nosocomial sinusitis in ventilated patients. Nasotracheal versus orotracheal intubation.

A total of 68 postoperative patients whose lungs were ventilated for more than 4 days were studied prospectively during a one-year study period to investigate the effect of the mode of intubation on the paranasal sinuses. After an initial X ray of the skull showing no pathological findings, patients were assigned randomly to one of the study groups; the lungs of patients in group A were ventilated via an orotracheal tube (n = 32), and patients in group B via a nasotracheal tube (n = 36). X ray examinations of the sinuses were performed at regular intervals. Diagnosis of sinusitis was confirmed by transantral needle puncture and culture of fluids obtained. Antibiotic regimens were altered according to laboratory testing. Two patients in group A developed signs of sinusitis in comparison to 15 patients in group B (p less than 0.01). However, there were significantly more airway complications in the orotracheal group, particularly during the period of weaning from ventilation. We conclude that orotracheal intubation should be preferred as the routine route of intubation.

Aged↗
PubMed1992

Intermittent positive pressure ventilation through a laryngeal mask airway. Is a nasogastric tube useful?

A nasogastric tube was used to aspirate air insufflated into the stomach during intermittent positive pressure ventilation through a laryngeal mask airway and a tracheal tube. No difference was found in the amount aspirated between patients with a tracheal tube, a laryngeal mask airway with the nasogastric tube closed or a laryngeal mask airway with the nasogastric tube open, when the nasogastric tube was aspirated at 15 min intervals for the first hour of anaesthesia.

Adult↗
PubMed1975

Delayed C.N.S. complications.

Patients with esophageal stricture being treated with dilatation, who developed esophageal perforation or local peritonitis and subsequent central nervous system infection, are reviewed. It is suggested that the vertebral venous system may be the route by which the metastatic infection is carried. Physicians caring for patients with esophageal stricture, who are receiving dilatation, should be aware of the possible intracranial complications and should be alert to the first sign of central nervous system abnormality.

Brain Abscess↗
PubMedDate not supplied

Middle ear pressure during and after prolonged nasotracheal and/or nasogastric intubation.

Changes in middle ear pressure during and after prolonged nasotracheal and/or nasogastric intubation were studied in 47 patients who had been intubated, for various reasons, during 1-24 days. All the patients had a negative middle ear pressure; in 84% of the ears the pressure was -200 mm of water or less. In most ears the pressure fell rapidly after the intubation, being most negative before extubation and during the first 2 days after. In all patients who could be followed the pressure returned to normal. The normalization was slow, depending upon the duration in intubation. Possible causes, such as abolished ventilation of the rhinopharynx, insufficient swallowing, mechanical occlusion of the tubal orifice, and the influence of anaesthetic gases are discussed. During the period after extubation the most probable cause is irritative and inflammatory reaction of the mucosa, leading to internal tubal occlusion.

Adult↗