Pulmonary complications in the patient with acute head injury: neurogenic pulmonary edema

Article Abstract:

Neurogenic pulmonary edema (NPE) is an acute condition in which the lung contains an excess amount of water, and occurs after a sudden increase in the blood pressure within the skull (intracranial pressure, or ICP). Symptoms of NPE include increased rate of breathing, increased heart rate, a bloody cough, chest pain, and possibly a low-grade fever. NPE may lead to the collapse of the lung, respiratory failure, adult respiratory distress syndrome, and death. Causative factors of NPE include bleeding within the brain, sudden brain trauma, damage to the upper part of the spinal cord, and convulsive disorders. These injuries increase intracranial pressure, but the exact mechanism of how this translates into pulmonary edema is not known. Increased ICP may cause a sudden discharge of nerve impulses that dramatically increases blood flow to the heart and lungs resulting in lung tissue damage and edema. Two structures of the brain called the hypothalamus and medulla are thought to contribute to this process. The type of nursing care a patient receives may make a difference in the patient's outcome. The nursing of NPE is directed at maintaining pulmonary function while preventing further increases in ICP. The patient should be placed in an upright sitting position, but should not be at a 90 degree angle to the floor. The frequent slow turning of the patient is also recommended to prevent further increases in ICP. NPE patients may be placed on respiratory support, have fluid suctioned from their lungs, and receive morphine to help prevent increases in ICP, but these strategies may increase ICP further. Drugs called diuretics that promote the excretion of water from the body are a mainstay treatment of ICP and NPE. It is suggested that irritating procedures such as suctioning, turning, and bathing be avoided in the first 48 hours after the development of ICP. Patients with NPE who receive expert nursing care may have an increased chance of survival. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Prevention, Pulmonary edema, Intracranial pressure

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Incidence of pulmonary aspiration in intubated patients receiving enteral nutrition through wide- and narrow-bore nasogastric feeding tubes

Article Abstract:

Proper nutrition is vital to the outcome of critically ill patients, and the digestive tract is the best route for supplementation. Previously, wide-bore tubes were inserted through the nose (nasogastric tubes) into the digestive tract, but they often caused sore throat, ear infection, erosion of the trachea and esophagus, and problems with the muscle closing the lower entry from the stomach to the esophagus. The primary advantage of the wide-bore tube was ease of removal of fluid from the stomach and lower risk of introducing matter into the lungs (pulmonary aspiration). Narrow-bore tubes are flexible and more readily tolerated, but they are more likely to move out of position, resulting in increased pulmonary aspiration, a major complication of enteral feeding. The frequency of aspiration into the lungs with wide- and narrow-bore tubes was compared in a group of 25 patients. It was found that nurses checked patients with wide tubes more often than those with narrow tubes. The narrow tubes tended to collapse when nurses checked for residual amounts of fluids, and the inability to obtain the residual led to a decrease in nursing vigilance in assessing gastric distention, an important factor in reducing the risk of aspiration. X-ray is the only consistently reliable method of ensuring correct placement; however, even X-ray only shows that it was correctly placed at that time. Nurses often choose the type of nasogastric tube, and should be aware of the different characteristics of wide- and narrow-bore tubes. Frequent assessment should be stressed, and in selecting the type of tube, nurses should note that assessment is performed more consistently with a wide-bore tube. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Tube feeding

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Contamination of enteral feedings and diarrhea in patients in intensive care units

Article Abstract:

Enteral or tube feeding is a commonly used method for providing nutrition to patients who are seriously ill. However, enteral feedings are accompanied by a high incidence of diarrhea (which has been reported in 32 to 68 percent of enteral feeding patients). Although this diarrhea is thought to be caused by a complex of different factors, the underlying mechanisms are not well understood. The present experiment investigates the value of using an aseptic (sterile) delivery mechanism of enteral solution to one group of adult patients in various intensive care units of a hospital. The rate of diarrhea in this group was compared to that of a group who received conventional enteral support. Samples of the enteral fluid fed to both groups was also sampled and analyzed for bacterial contamination. There was no significant difference in the incidence of diarrhea between the two groups; consequently, bacterial contamination of feeding formulas is not considered to be a major source of diarrhea in enterally fed patients. The rate of bacterial contamination, however, was found to be higher in the group who received conventional enteral feedings than in the aseptically fed group. Other factors, such as the severity of the patients' illness, the osmolarity of the solution, and the rate of formula administration, were found to have no effect on the incidence of diarrhea. In general, the findings demonstrate that the use of closed sterile bags (which do not require further handling) reduces the rate of bacterial contamination of enteral formula, and this method is recommended for patients who require enteral feedings. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diarrhea, Contamination, Solutions (Pharmacy)

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