Presence Of Bowel Sounds Research Articles

Optimal initial diet in mild acute pancreatitis: A comprehensive meta-analysis of randomized control trials

ObjectiveWe performed a comprehensive systematic review and meta-analysis comparing initiation of full solid diet (FSD) versus stepwise diet to better define the management of patients with mild acute pancreatitis (AP). MethodsElectronic databases were searched through August 2, 2021 for trials comparing initial FSD versus stepwise advancement in patients with mild AP on length of hospital stay (LOHS). We stratified by whether diet was initiated early (within 24 h or immediately upon presence of bowel sounds). ResultsWe identified seven RCTs that compared LOHS in AP patients who received initial oral intake with solid diet versus stepwise diet. Across the studies a total of 305 patients were randomized to immediate FSD and 308 patients to sequential advancement. Patients who were initiated on a FSD had a significant reduction in total LOHS (Standardized Mean Difference (SMD) −0.52 [95% CI -0.69, −0.36]). There was no difference in post refeeding abdominal pain, tolerance of diet, or necessity to cease diet between the two groups. Sub-analysis of three studies that initiated FSD early reduced total LOHS (OR -0.95 [95% CI -1.26, −0.65]) compared to those who received graded diet advancement as well as higher likelihood of tolerating the assigned diet (OR 6.8 [95% CI 1.2, 39.2]). ConclusionsOur meta-analysis shows that initiation of FSD reduces total LOHS in patients with mild AP and does not increase post refeeding abdominal pain. Though additional high-quality studies are needed, these findings support initial solid diet for AP and consideration of feeding within the first 24 h.

A Quasi Experimental Study to Evaluate the Effectiveness of Selected Nursing Interventions (Steam Inhalation, Deep Breathing Exercises and Ambulation) in Terms of Physiological Parameters and Selected Post-operative Outcomes among Patients Undergoing Abdominal Surgery in Selected Hospital of Delhi, India

Introduction & Background of the Study: Surgery is one of the unique experiences for the individual. There is an increased demand of oxygen to the cells of the body during this period. Patients may have some impairment of respiratory functions after surgery. If it is not treated earlier it may lead to development of respiratory complications such as hypostatic pneumonia, atelectasis, and respiratory failure. In post operative period patient has a greater risk of alteration in the physiological parameters. Postoperatively 30% patients experience alteration in physiological parameters. Documentation of vital signs aids management decisions, indicating the physiological derangement of a patient and dictating treatment. Physiological parameters monitoring in the perioperative period for moderate- and high-risk surgical patients can improve postoperative outcome. Steam inhalation Deep breathing, coughing exercises and ambulation helps in oxygenation of the tissues However improvement in physiological parameters and post-operative outcomes delivered the overall quality of care. Aim: The study is to assess the effectiveness of selected nursing interventions (steam inhalation, deep breathing exercises and ambulation) regarding post-operative outcomes in terms of physiological parameters (temperature, pulse, respiration, blood pressure, pain) and selected post-operative outcomes (presence of cough, presence of bowel sounds, passage of flatus, passage of stool, amount of nasogastric tube aspiration, amount of abdominal drainage, activities of daily living, oral feeding, day of foleys catheter removal and days of hospital stay) among abdominal surgery patients. Material & Methods: A quasi-experimental pre-test post-test control group research design was adopted on 60 patients by using purposive sampling technique. 30 patients for control group and 30 patients for experimental group. A self-prepared observation checklist was used before and after implementation of nursing interventions to assess the physiological parameters and selected post-operative outcomes. Conclusion: It was concluded that physiological parameters were more stable and better results were observed in terms of post-operative outcomes in the experimental group than the control group.

A Comparative Study of Early versus Conventional delay in Postoperative oral intake in Women undergoing Cesarean Section under regional anaesthesia

The rate of cesarean delivery is increasing around the world. A traditional graduated dietary regimen, “nothing by mouth” for 24 hours, or until the presence of bowel sounds or passing flatus is still practised after cesarean delivery. In recent studies, an early oral intake has been recommended instead of the traditional dietary regimen for women after cesarean delivery. Our study aims at comparing the safety and efficacy of early versus conventional post-operative oral intake in patients undergoing caesarean section under regional anaesthesia. It is a prospective comparative study involving 308 patients (153 in study group and 155 in the control group) with strict inclusion and exclusion criteria. The outcomes assessed included incidence of paralytic ileus, time interval for bowel movements to appear, duration of intravenous fluid administration and length of hospital stay. In our study none of the patients in the study group developed ileus and 6.44% in the control group had ileus. Women in the early feeding group had a more rapid return of bowel function, with a substantially shorter mean postoperative time interval to the first active bowel movement. The duration of intravenous fluid administration in the study group was lesser and was statistically significant.. This study also confirmed that the early feeding regimen for patients after uncomplicated cesarean section was well tolerated. Also it offers other benefits to the patients such as less suffering from thirst and hunger, shorter hospital stay and reduced hospital expenses. Further studies with larger sample sizes may be needed to confirm the above observations with statistical significance.

Two-stage resection for malignant colonic obstructions: the timing of early resection and possible predictive factors.

To study potential predictive factors for early radical resection in two-stage resection for left malignant colonic obstruction. Thirty-eight cases of left-sided obstructive colon cancer undergoing two-stage operations were reviewed between January 1998 and August 2008. Patients were classified into two groups (n = 19 each): early radical resection (interval ≤ 10 d) and late radical resection (interval > 10 d). Baseline demographics, post-diversion outcome, perioperative data, tumor characteristics, outcome and complications were analyzed. The baseline demographics revealed no differences except for less pre-diversion sepsis in the early group (P < 0.001) and more obstruction days in the late group (P = 0.009). The mean intervals of early and late radical resections were 7.9 ± 1.3 d and 17.8 ± 5.5 d, respectively (P < 0.001). After diversion, the presence of bowel sounds, flatus, removal of the nasogastric tube and the resumption of oral feeding occurred earlier in the early group. The operation time and duration of hospital stay were both significant reduced in the early group. Complication rates did not differ between groups. The earlier recovery of bowel function seems to be predictive of early radical resection. In contrast, pre-diversion sepsis and more obstruction days were predictive of delayed radical resection.

Comparison Of Laparoscopic Vs Open Appendicectomy In A Low-Volume General Hospital. A Pilot Study

Introduction: Laparoscopy is a safe procedure for diagnostic and therapeutic purposes in patients with suspected acute appendicitis. Nevertheless, the optimal approach in a low-volume hospital is still under debate. Aim: In this pilot study we are testing the laparoscopic approach against the traditional open technique in terms of postoperative pain, gastrointestinal quality of life and return to normal physical activities. Patients Methods: Forty patients with right iliac fossa pain were randomised into two groups after written informed consent. Group A consisted of 20 patients who underwent laparoscopy and laparoscopic appendicectomy. Group B included 20 patients submitted to open appendicectomy by the same single surgeon. The postoperative pain (Numeric Rating Scale 1-10), the need for analgesics (number of tramadol 100mg doses) and the functional status (climbing stairs and mounting a bed – 1 = no difficulty, 2 = moderate difficulty and 3 = severe difficulty) were measured at days 1, 2 and 7 after the operation. The presence of bowel sounds was also checked 6, 12, 24 and 48 hours postoperatively. Results: The two groups were comparable in age and gender. There was no significant difference in the operative time (p = 0.666), postoperative pain on day 1 (p = 0.113) and function score. Group A had significantly less pain on days 2 and 7 (p = 0.014 and p < 0.001, respectively), less need for opioids (p = 0.05), earlier bowel mobilisation (p = 0.006) and shorter hospital stay (p = 0.014). Conclusions: Laparoscopic appendicectomy in a low-volume district hospital is a safe operation if performed by experienced surgeons. With the limitations of the small samples size, laparoscopic approach was superior to open in terms of postoperative pain, need for analgesics, bowel mobilisation and hospital stay.

Cardioversor desfibrilador implantável em criança com miocárdio não-compactado isolado

CLINICAL DATA9-year-old male child, 25 kg, from Barretos, Sao Paulo.Full-term patient presenting cardiorespiratory arrest (CRA)without defined cause and remained for 30 days in IntensiveCare Unit (ICU). At 11 months presented episode of fainting,followed by cyanosis and CRA. He had undergonecardioversion due to ventricular fibrillation (sic). At thetime, corticoid and digitalis were used, and the patientevolved well until the last two months, when presentednew fainting episode at rest, requiring cardiac massage andnew cardioversion to revert this presentation. Amiodarone,spironolactone, aspirin and suspension of digitalis wereadministered. After about 10 episodes of syncope andfainting, the child was referred to the ICU of our Service.On physical examination the patient was in good generalcondition, afebrile, acyanotic and eupneic. Precordiumunchanged, regular heart rhythm, with normal and rhythmicsounds. Pulmonary auscultation was normal. Flaccidabdomen, liver at 2 cm from the right costal margin, spleennot palpable and presence of bowel sounds. Goodperipheral perfusion, without edema, palpable andsymmetrical pulses in all limbs, without motor sequels withonly mild mental retardation, resulting from the CRA at thetime of parturition (sic).ELECTROCARDIOGRAMSinus rhythm, heart beat of 88 bpm, SÂP 0°, SÂQRS -30°, PR interval 0.24s. First-degree AV block, atrial and leftventricular overload, and left branch block.RADIOGRAMVisceral

Laparoscopic Colectomy

Laparoscopic colectomy can be performed using 2 approaches: lateral or medial. However, it is unknown if one of these techniques provides better results. Thus, the object of the present study is to assess whether one of the approaches has any potential benefits over the other. A comparative, retrospective study was performed that included all patients scheduled for left and right laparoscopic colon resection for both neoplastic and benign diseases between June 2000 and June 2006. The following factors were assessed: operation time, recovery variables (bowel sounds, passage of gases, intake of liquids and solids), length of hospital stay, and morbidity and mortality rates. The population was divided into 4 groups: right colectomy using a lateral approach (RL); right colectomy using a medial approach (RM); left colectomy using a lateral approach (LL); and left colectomy using a medial approach (LM). A total of 202 patients were evaluated: RL: 16 (8%); RM: 37 (18.3%); LL: 110 (54.4%); LM: 39(19.3%). No differences in recovery parameters were observed between the right colectomies. However, the presence of bowel sounds and solid intake was significantly earlier in the patients subjected to left colectomies using a medial approach. A tendency toward a higher conversion rate was observed in left colectomies with lateral approach (LL: 18 vs. LM: 1, P=0.052). The operation time was significantly shorter when a medial approach was used for both right and left colectomies (RL: 185.6 min vs. RM: 148.6 min, P=0.009; LL: 205.5 min vs. LM: 139.9 min, P<0.0001). No differences in the morbidity and mortality rates were found between lateral and medial approach in both types of colectomy. The use of a medial approach in a laparoscopic colectomy provides short-term benefits compared with a lateral approach.

A randomised controlled trial of early initiation of oral feeding after cesarean section

Objective. To evaluate the safety and efficacy of early oral feeding after cesarean delivery.Methods. Two hundred women who had cesarean section were randomly assigned to early feeding or routine feeding. Women in the early feeding group were encouraged to take sips of water 8 h post-operatively, followed by oral tea of 100 mL at the time of supervision. Women in the routine feeding group were managed by restricting oral intake for the first 24 h and administration of sips of water 24–48 h post-operatively. The outcome measures include the rate of ileus symptoms, post-operative time interval to presence of bowel sounds, passage of flatus and bowel movement, time interval to return to regular diet, length of hospital stay, post-operative complications, acceptability and benefit of early oral feeding.Results. The early feeding group had a shorter mean post-operative time interval to bowel sounds 18.90 ± 4.17 h versus 36.21 ± 3.52 h (p < 0.001), passage of flatus 44.81 ± 3.73 h versus 60.58 ± 4.40 h (p < 0.001) and bowel movement 58.30 ± 5.91 h versus 72.76 ± 4.25 h (p < 0.001). There was no significant difference in paralytic ileus symptoms. Early feeding group had a shorter mean hospital stay 4.80 ± 0.59 days versus 6.69 ± 0.71 days (p = 0.001). Early feeding group required less intravenous fluid 7.14 ± 1.34 bottles versus 11.8 ± 1.32 bottles (p < 0.001).Conclusions. Early feeding after cesarean section was well tolerated and safe and can be implemented without an increase in adverse outcome.

Does postoperative misoprostol use induce intestinal motility? A prospective randomised double‐blind trial

Misoprostol has been shown to increase colonic activity and decrease colonic transit time in chronic constipation patients. The aim of this prospective, randomised, double-blind study was to examine the effectiveness of rectally administered misoprostol on inducing intestinal motility after gynaecological surgery. Eighty women who underwent hysterectomy were divided randomly into three groups. Group A received misoprostol 200 microg rectally while group B received 400 microg rectal misoprostol after surgery before leaving the operating room. Patients in group C received no drugs. Bowel sounds in four quadrants were checked every hour and possible side-effects of misoprostol like nausea, vomiting, and distension were evaluated. The time interval between surgery and flatus pass and the need of analgesics were noted. Statistical analyses were done with Mann-Whitney U-test and chi2 tests where available. The time between surgery and presence of bowel sounds in four quadrants were similar in all groups (2.7 +/- 1.6, 2.9 +/- 1.2, 2.8 +/- 1.3 h, for groups A, B, and C, respectively). No difference was observed in flatus pass time. The incidence of nausea was significantly increased in group B compared to controls (P < 0.01). Additional analgesic need was significantly higher in groups A and B when compared to controls (P < 0.05 and P < 0.01, for groups A and B, respectively). Rectally administered misoprostol does not improve intestinal motility in the early postoperative period and thus, it is not effective in providing early oral food intake. On the contrary, it causes distention that requires additional analgesics and vomiting that naturally limits oral diet intake.

Realimentacion digestiva en pancreatitis aguda: ¿Cuándo y cómo?

Digestive refeeding in acute pancreatitis represent a difficult issue. It requires the resolution of intestinal ileus and carries a risk of reactivation. To evaluate criteria that may guide in early refeeding avoiding unnecessary prolonged fasting. Thirty patients with acute pancreatitis were evaluated in a prospective trial. The severity of the pancreatitis was evaluated according to APACHE II score and Balthazar CT scan alterations. The criteria proposed to start early refeeding were absence of nausea and vomiting, decreased abdominal pain, presence of bowel sounds and lowering of serum amylase levels. Balthazar CT scan classification, was used to decide between oral or enteral refeeding. Eighty percent of patients had alterations in pancreatic density, necrosis or pancreatic or peripancreatic liquid collections in the CT scan (corresponding to Balthazar stages C, D, or E). Ten patients fullfilled the criteria for enteral refeeding at 8.1 +/- 3.5 days (range 3 to 15 days), and 21 patients fulfilled criteria fo enteral refeeding at 8.7 +/- 4.5 (range 4-19). No patient had a reactivation of his pancreatitis. Digestive refeeding can be done safely by using the criteria proposed in this study. Pancreatic necrosis or peripancreatic fluid collections do not contraindicate refeeding. Oral feeding may be employed (as the first option) in selected patients, without increasing the risk of complication, regardless of CT scan alterations of the pancreas.

Enteral nutrition in the critically ill patient: a prospective survey.

To describe current enteral nutrition-prescribing practices for critically ill patients, and to identify factors associated with initiation of, and tolerance to, enteral nutrition. A prospective, cohort study. Two tertiary care medical-surgical intensive care units (ICU) in Ontario, Canada. We enrolled 99 consecutive patients who were expected to stay in the ICU for > 3 days and who were unable to tolerate oral nutrition. We followed patients for 21 days or until they tolerated enteral nutrition, tolerated oral nutrition, were discharged from the ICU, or died. We recorded time elapsed from ICU admission to initiation and tolerance of enteral feedings, and examined factors associated with these events. We defined tolerance as receiving 90% of estimated daily energy requirements for > 48 hrs without gastrointestinal dysfunction (i.e., high gastric residuals, vomiting, diarrhea, abdominal distention). Seventy-three (74%) of 99 patients were started on enteral feedings an average 3.1 days (range 1 to 18) after ICU admission. Of 26 patients never started on enteral nutrition, three (12.5%) patients eventually tolerated oral nutrition, 14 (54.0%) patients were discharged from the ICU, and seven (27.0%) patients died. Reasons for not initiating enteral nutrition included absence of bowel sounds (27.0%), high nasogastric drainage (16.9%), contraindication to enteral nutrition (16.7%), tolerance of oral nutrition (6.8%), and no apparent reason (5.1%). Abdominal surgery, use of vasoactive drugs, and admission to one hospital made initiation of enteral nutrition less likely, whereas presence of bowel sounds and admission to the other hospital made initiation of enteral nutrition more likely. Thirty-five (42.9%) of 73 patients started on enteral nutrition achieved tolerance of the regimen. The average time from ICU admission to tolerance of feedings was 5.8 days (range 1 to 14). Once started on enteral nutrition, the most common reasons for decreasing or discontinuing feedings included high gastric residuals (51.0%), mechanical feeding tube problems (15.4%), medical or surgical procedures (5.4%), and vomiting (5.1%). Use of paralytic agents and the presence of high gastric residuals were associated with intolerance. Of 38 patients who did not achieve tolerance, 20 (52.6%) patients were discharged from the ICU, eight (21.0%) patients died, and eight (21.0%) patients eventually tolerated oral nutrition. Enteral nutrition is not started in all eligible ICU patients. Approximately half of those patients receiving enteral nutrition achieved tolerance of the regimen. Gastrointestinal dysfunction causing intolerance to enteral nutrition is a common reason for not starting, or discontinuing, feedings.