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Background: Enteral feeding intolerance (EFI) occurs in more than one-third of mechanically ventilated patients, yet the cause of this gastrointestinal dysfunction remains unclear. Assessment and diagnostic criteria are often vague and subjective leading to inaccurate recognition or diagnosis of EFI. Nurses are often unsure or unaware of appropriate assessment methods. Objectives: The objective of this descriptive study was to determine current practice for assessment of EFI among critical care nurses. Methods: A national survey to explore EFI assessment practices was conducted with critical care nurses at the American Association of Critical-Care Nurses National Teaching Institute conference in 2022. Nurses completed a 19-item survey to determine assessment practices for EFI among critical care nurses. Results: A total of 344 nurses completed the survey. The majority of nurses practiced direct care at the bedside for adult critical care patients, held a bachelor's degree, had 6 to 15 years of nursing experience, and held specialty certification. There was variability among responses to the practice questions in the survey. Seventy-eight percent of the nurses were aware of and had cared for patients with EFI. EFI was assessed by 84% of participants. The most common assessment criterion for EFI was nausea and vomiting. The majority (81%) of respondents measured gastric residual volume routinely or sometimes. Discussion: This study shows assessment of EFI is not standardized among nurses. This study identifies a need for education about EFI given the lack of understanding of EFI. Findings from this study can be used to inform future research to develop best methods for assessing the presence of EFI. [ABSTRACT FROM AUTHOR]

BACKGROUND: Venous thromboembolism (VTE) is the fourth most common preventable hospital-acquired complication for hospitalized trauma patients. Mechanical prophylaxis, using sequential compression or intermittent pneumatic compression (IPC) devices, is recommended alongside pharmacologic prophylaxis for VTE prevention. However, compliance with device use is a barrier that reduces the effectiveness of mechanical prophylaxis. OBJECTIVE: This study aimed to determine whether using the Movement and Compressions (MAC) system compared with an IPC device impacts compliance with mechanical VTE prophylaxis in trauma patients. METHODS: This study used a before-and-after design with historical control at a Level II trauma center with a convenience sample of adult trauma patients admitted to the intensive care unit or acute care floor for at least 24 h. We trialed the MAC device for 2 weeks in November and December 2022 with prospective data collection. Data collection for the historical control group occurred retrospectively using patients from a point-in-time audit of IPC device compliance from August and September of 2022. RESULTS: A total of 51 patients met inclusion criteria, with 34 patients in the IPC group and 17 patients in the MAC group. The mean (SD) prophylaxis time was 17.2 h per day (4.0) in the MAC group and 7.5 h per day (8.8) in the IPC group, which was statistically significant (p <.001). CONCLUSION: Our findings suggest that the MAC device can improve compliance with mechanical prophylaxis. [ABSTRACT FROM AUTHOR]

The article presents the answer to a question about the use of high-dose vasopressors in enteral nutrition.

Background: Bedside methods to verify placement of a feeding tube are not accurate for detecting placement within the gastrointestinal tract, increasing risk of pulmonary aspiration. Current guidelines recommend verifying placement every 4 hours, yet the rationale for this recommendation is unknown. Objective: To assess spontaneous migration of small-bore feeding tubes in critically ill adults. Methods: A prospective, repeated-measures cohort study was performed in 2 intensive care units. An electromagnetic placement device was used to assess distal feeding tube location every 24 hours for 7 days. Tube migration between zones—esophageal, gastric, and postpyloric— was considered clinically significant. Results: Feeding tubes were analyzed in 20 patients. Interrater agreement was substantial for round 2 of a blinded analysis of insertion tracings (g = 0.78); 100% agreement was achieved after unblinding. Among 62 outcomes (migration assessments), 4 feeding tubes migrated 8 times (3 forward and 5 retrograde). All migrations occurred in the postpyloric zone and none were clinically significant. Within 24 hours of insertion, 50% of feeding tubes had migrated forward. Repeated-measures analysis showed a greater likelihood of migration in patients with an endotracheal tube (relative risk, 3.46 [95% CI, 1.14-10.53]; P =.03). Conclusions: No tubes migrated retrograde into the stomach or esophagus, challenging the practice of verifying placement every 4 hours. Verification every 24 hours may be adequate if migration is not suspected. Also, lack of visible anatomical structures on insertion tracings from an electromagnetic placement device make subtle changes in postpyloric placement difficult to identify accurately. [ABSTRACT FROM AUTHOR]

Background: A variety of techniques are used for placement of small-bowel feeding tubes. Standard practice at the study institution is for postpyloric placement using an electromagnetically guided placement device (EMPD). EMPD placement is performed by bedside nurses trained in the placement technique and may reduce radiograph exposures and time to initiation of enteral nutrition. Objectives: To evaluate how changes in SBFT placement verification procedures in critical care patients-from use of EMPD with radiographic confirmation, to placement verification by using EMPD without radiographic confirmation-influenced successful placement, misinterpretations of locations, and radiographic verification of tube locations. Methods: The research was conducted at an 800-bed quaternary care referral hospital located in the Midwest. Nine-hundred four feeding tubes were placed in 632 critical care patients by using bedside EMPD instead of radiographic confirmation as the standard of care. Prospectively collected EMPD audit form data were retrospectively analyzed. Results: Small-bowel (duodenum or jejunum) placement was achieved by bedside nurses in 97.2% of all EMPD placements, with 2.8% placed in the stomach because gastric placement was ordered or small-bowel placement could not be achieved. Radiographic confirmation was required in only 7.7% of placements. No adverse events or pulmonary placements occurred. Conclusions: Use of EMPD technology allowed clinicians to safely and effectively place feeding tubes at the bedside and eliminate radiographs in most cases. EMPD placement was not limited to specialized nurses or teams. This procedure should be easily reproducible in other critical care environments. [ABSTRACT FROM AUTHOR]

Background Research has demonstrated the hazards associated with patients' bath basins and microbial contamination. In a previous study, soap and water bath basins in 3 acute care hospitals were found to be reservoirs for bacteria and potentially associated with the development of hospital-acquired infections. Bacteria grew in 98% of the basin samples; the most common were enterococci (54%), and 32% were gram-negative organisms. Objective To assess the presence of bacterial contaminants in wash basins when chlorhexidine gluconate solution is used in place of standard soap and water to wash patients. Methods Bathing with chlorhexidine gluconate is the standard of practice for all patients in intensive care units at St Vincent Hospital. Specimens from 90 bath basins used for 5 days or more were cultured for bacterial growth to assess contamination of basins when chlorhexidine gluconate is used. Results Of the 90 basins cultured, only 4 came back positive for microbial growth; all 4 showed growth of gram-positive organisms. Three of the 4 organisms were identified as coagulase- negative staphylococcus, which is frequently found on the skin. This translates into a 95.5% reduction in bacterial growth when chlorhexidine gluconate is used as compared with soap and water in the previous study (Fisher exact test, P < .001). The only factor that was related to positive cultures of samples from basins was the sex of the patient. Discussion Compared with the previous study examining microbial contamination of basins when soap and water was used to bathe patients, bacterial growth in patients' bath basins decreased significantly with the use of chlorhexidine gluconate, drastically reducing the risk for hospital-acquired infections. Such reduced risk is especially important for critically ill patients at high risk for bacterial infection. [ABSTRACT FROM AUTHOR]

Background Fecal contamination is a major challenge in patients in acute/critical care settings that is associated with increased cost of care and supplies and with development of pressure ulcers, incontinence dermatitis, skin and soft tissue infections, and urinary tract infections. Objectives To assess the economic impact of fecal containment in bedridden patients using 2 different indwelling bowel catheters and to compare infection rates between groups. Methods A multicenter, observational study was done at 12 US sites (7 that use catheter A, 5 that use catheter B). Patients were followed from insertion of an indwelling bowel catheter system until the patient left the acute/critical care unit or until 29 days after enrollment, whichever came first. Demographic data, frequency of bedding/dressing changes, incidence of infection, and Braden scores (risk of pressure ulcers) were recorded. Results The study included 146 bedridden patients (76 with catheter A, 70 with catheter B) who had similar Braden scores at enrollment. The rate of bedding/dressing changes per day differed significantly between groups (1.20 for catheter A vs 1.71 for catheter B; P = .004). According to a formula that accounted for personnel resources and laundry cycle costs, catheter A cost $13.94 less per patient per day to use than did catheter B. Catheter A was less likely than was catheter B to be removed during the observational period (P = .03). Observed infection rates were low. Conclusion Catheter A may be more cost-effective than catheter B because it requires fewer unscheduled linen changes per patient day. [ABSTRACT FROM AUTHOR]

The article discusses how to effectively manage ventilator-associated pneumonia (VAP). VAP poses a problem to mechanically ventilated patients, which results to increased morbidity and mortality. It is a pervasive threat to ventilate patients with an incidence as high as 65% and a mortality rate of 71%. VAP patients incur hospital costs of $57,000 per occurrence along with a longer length of stay and increase ventilator days.

Purpose. Two cases of malignant hyperthermia suspected to be related to the use of a nondepolarizing neuromuscular blocker are reported. Summary. A pharmacogenetic disorder that may occur in as many as 1 in 3000 anesthesia procedures, malignant hyperthermia has been linked to the use of certain anesthetic gases and depolarizing neuromuscular blocking agents (e.g., succinylcholine). Although nondepolarizing neuromuscular blockers were cited as contributing to the development of malignant hyperthermia in a small number of published reports, the agents are generally considered safe for use in at-risk patients. Here investigators report two cases in which the nondepolarizing agent rocuronium is thought to have triggered malignant hyperthermia in patients with no known history of the disorder. In one case, a critically ill 27-year-old man undergoing an induced-hypothermia protocol developed a fever about 4 days after receiving rocuronium infusions, with temperatures rising over 11 days to a maximum of 105.2 °F. In the other case, a 63-year-old man being treated for serious complications of elective surgery developed extreme fever (maximum temperature of 107.1 °F) about 4 days after receiving two bolus doses and a continuous infusion of rocuronium. In both cases, the discontinuation of rocuronium therapy was followed by the rapid diminution of fever over 12-36 hours. After consultations with medical staff and consideration of other potential causal and contributory factors (e.g., neurologic injury, antimicrobial-induced fever), rocuronium was deemed the most likely trigger of the severe febrile response experienced by these two patients. Conclusion. A 27-year-old man and a 63-year-old man received rocuronium and subsequently developed delayed-onset malignant hyperthermia, which resolved after the rocuronium was discontinued. [ABSTRACT FROM AUTHOR]