1
عمومی::
لولۀ تغذیه
Patients who are not intubated and who are unable to eat because of an altered sensorium, sedatives, narcotics, or anorexia should have a small-bore nasogastric tube placed as well. ftese tubes are readily tolerated and are not as prone to clogging as pure feeding tubes; they also allow for gastric suctioning and decompression should that be required. fte nutritional plan should never be "the patient will start eating tomorrow" because more often than not tomor- row never comes, and the patient's nutritional deficits become even greater. fte advantages of enteral nutrition continue to accrue in the literature and include maintaining gut integrity, trophic effects on the liver, increased intestinal immunoglobulin production, decreased infection rates, and more stable glycemic profiles.
Patients undergoing elective surgery are kept NPO for 8 hours before intubation for fear of gastric aspira- tion; however, this reason does not make sense in an ICU patient with a critical need for nutrition who has a cuffed tube in the airway as well as a gastric tube for decompression. ftese patients should have their tube feeding stopped immediately before leaving the ICU for the operating room, their nasogastric tube or feeding tube flushed, and the stomach decompressed via suctioning.
Patients with ongoing elevated GRV and feeding intolerance require a thoughtful evaluation because new-onset feeding intoler- ance is often a harbinger of impending sepsis or infectious com- plications. fte medical record and bedside nurse should be queried to determine when the patient last had a bowel move- ment, and a digital rectal examination should be performed looking for fecal impaction. fte feeding tube should be checked for patency and proper location on radiographs, which may also yield data on the presence of ileus, pseudo-obstruction, or suspected pneumonia, all of which are associated with feeding intolerance.
Patients who continue to fail attempts at gastric feeding can be treated with prokinetic agents such as erythromycin or metoclopramide or receive a postpyloric feeding tube.
Alterations in mental status, craniectomy, or monitoring devices render meningitis a possibility, whereas nasogastric or feeding tubes make sinusitis more likely.
واژگان شبکه مترجمین ایران