Tube In Intensive Care Unit Research Articles

Antibiotic Resistance and Biofilm Formation in Gram Negative Bacteria Isolated From Endotracheal Tubes in Intensive Care Unit of a Tertiary Care Hospital

Biofilm formation has been found to play a central role in many human infections in which antibiotic resistance is common. Bacteria can colonize and form biofilms on almost any surface, including natural and synthetic surfaces the present study was conducted with an aim to detect biofilm formation in ET tubes/ ET secretions received from ICU patients by microtiter plate method. In the present study a total of 85 isolates were obtained out of 400 samples. Among 85 isolates of gram- negative bacteria, maximum number of isolates were of K. pneumoniae (41.17%) followed by A. baumannii (40%), P. aeruginosa (10.5%), E. coli (5.88%) and B.cepacia (2.35%). All isolates were tested for antimicrobial sensitivity/resistance by Vitek 2 Compact system. All the isolates were further tested for biofilm production by microtiter plate method and optical density (OD value) was measured. Biofilm production was distributed by strong, medium, and weak. It is concluded that stringent hygiene protocols, routine tube changes and the use of antimicrobial coatings are crucial for prevention of biofilm development in ICU settings.

Drug Administration via Feeding Tube in Intensive Care Unit: A Cross-sectional Study

Aim: The aim of this study was to evaluate the appropriateness of the administration of drugs in critically ill patients receiving enteral feeding support. .
 Materials and methods: This prospective, observational, and descriptive study was conducted in the reanimation unit of a university hospital. A clinical pharmacist on the intensive care team evaluated the drug administration of enterally fed patients at daily visits. The necessary interventions for incorrect drug administration via the feeding tube detected in the patient’s treatment were reported to the responsible physician.
 Results: Thirty patients who met the relevant criteria 2022 were included in the study. Fifteen (50%) of the patients were female, and the mean age of all patients was calculated as 49.16±20.23. It was determined that 76% of the patients received nutritional support via feding tube. The appropriateness of 74 drugs, 36 of which were different, administered via the feeding tube of these patients was evaluated. Thirty-three of the 36 medications were in solid dosage form Most of the drugs administrated by tube (94.6%) were in dose form appropriate for tube administration, whereas 17.56% of the administration method was incorrect.
 Conclusion: Unlike the recommendations, solid dosage forms are primarily applied in drug administrations made via feeding tubes. It is thought that the creation of algorithms that can be used in clinical practice for the correct method of administering the limited number of drugs available for application will contribute to the effectiveness and safety of the treatment.

Small-volume tubes to reduce anemia and transfusion (STRATUS): a pilot study.

Blood sampling for diagnostic testing causes blood loss. Small-volume tubes have the same cost, dimensions, and blood-draw techniques as standard-volume tubes, and are compatible with laboratory equipment; however, they are not commonly used. We sought to assess the feasibility of a stepped-wedge cluster trial to determine whether small-volume tubes reduce transfusion compared with standard-volume tubes in intensive care unit (ICU) patients. We conducted a prospective mixed-methods pilot study (before-after design) in one ICU with a six-week control period (standard-volume tubes) and a six-week intervention period (small-volume tubes). All patients admitted to the ICU were included. Feasibility was assessed as successful switch to small-volume tubes; adherence to tube size; sufficient volume for testing; user acceptance; barriers and facilitators to implementation; and 95% transfusion collection. We explored end-user acceptability using focus groups. One hundred and sixty-five patients were included in the standard-volume and 204 in the small-volume periods. Transition to small-volume tubes was successful. Random audits showed 100% compliance. The proportion of samples with inadequate volume for testing was the same for both groups (both, 0.2%). Based on ten focus groups, small-volume tubes were acceptable with no barriers identified. Transfusion data collection was 100%. Median [interquartile range] estimated blood loss due to laboratory testing per patient per day in ICU was 11 [8-17] mL with standard-volume and 6 [4-8] mL with small-volume tubes. Small-volume tubes can be implemented with acceptability to end-users and without barriers. They did not result in an increased frequency of inadequate samples. These results inform a trial to determine whether small-volume tubes reduce transfusion. ClinicalTrials.gov (NCT03284944); registered 15 September 2017.

Off-label use of drugs administered by enteral feeding tubes in an Intensive Care Unit in Fortaleza, Brazil

Objective: To analyze the prescription profile of drugs administered through enteral feeding tubes in an adult intensive care unit and gather recommendations for their safe administration. Methods: This is a descriptive and retrospective study conducted with adult critical clinical patients of a university hospital in Fortaleza-Ceará from March to May 2018. We performed analyses of patients’ medical records and prescriptions regarding drugs, pharmaceutical presentations and the possibility of administration through enteral tubes. Results: 489 prescriptions containing 1914 items were evaluated, from which 16.6% (n = 318) through tubes. Medicines for the cardiovascular system (34.6%), nervous system (27.4%) and digestive system and metabolism (15.1%) were the most predominant, with an average of 5.8 (DP: 4.2) different per patient. Regarding the pharmaceutical presentation, oral solids were frequently prescribed via enteral tube (67.9%), especially risperidone (8.8%), carvedilol (8.3%) and amiodarone (7.9%). There were contraindications for administration through tubes in 21.6% of solid oral formulations, while there were alternative standardized pharmaceutical forms in the hospital for 43.1%. In addition, substitution for liquid preparations from the market were possible in 43.1%. Among those to which there were no alternative formulations, drugs targeting the cardiovascular system prevailed (52.2%). A table with guidelines for the proper administration of the prescribed solid medications was elaborated then. Conclusion: Solid oral medications were frequently prescribed through enteral tubes, especially those for the cardiovascular system without alternative formulations, which shows the need for guidelines to promote the safety of this process.

Case Report of a Rare Complication of Tracheostomy Tube in Intensive Care Unit

Case Report of a Rare Complication of Tracheostomy Tube in Intensive Care Unit

Indications and outcomes of tracheostomy in intensive care unit

<p><strong> </strong></p><p class="abstract"><strong>Background:</strong> Tracheostomy is a commonly performed surgical procedure in the intensive care unit (ICU) in which creation of a stoma between the skin and the anterior wall of the trachea where there is need for prolong mechanical ventilation. Tracheostomy has considered a safe procedure in ICU but has been found to lead to life threatening complications intra and post operatively.</p><p class="abstract"><strong>Methods:</strong> This is a cross sectional study, was carried out in ICU, Chittagong Medical College Hospital, Chattogram from January 2018 to December 2019. A total of 120 patients irrespective of age and sex whose tracheostomy has done after admission in ICU by ENT surgeons. </p><p class="abstract"><strong>Results:</strong> Out of 120 patients maximum 34 (28.33%) were from 21-30 years age group and male to female ratio was 1.79:1, male patients were 77 (64.16%) and female patients were 43 (35.83%). The most common indication for tracheostomy in ICU was head injury and history of RTA 34 (28.33%) followed by post-operative case of intracranial space occupying lesion 30 (25%). Post tracheostomy complication was surgical emphysema 4 (3.33%). The rate of complication of tracheostomy in ICU was 10.83% in this study. Regarding benefits of tracheostomy over endotracheal tube in ICU, we found that 100% patients had greater comfort.</p><p class="abstract"><strong>Conclusions:</strong> Tracheostomy in ICU is an important and safe procedure if prolonged endotracheal in tubation is advised for varying underlying causes.</p>

Bedside placement of small-bowel feeding tube in Intensive Care Unit for enteral nutrition.

Enteral nutrition is the preferred mode of nutrition in critically ill patients whenever feasible as it has a number of advantages over parenteral feeding. Both gastric and small-bowel feeding can effectively deliver calories. In patients with gastroparesis, small-bowel feeding can help avoid parenteral feeding. We carried out a retrospective observational study to assess the ability to insert the Tiger 2 tube into the small bowel at the bedside in 25 patients who failed to tolerate gastric feeds. The time taken, rate of successful insertion, and ability to feed these patients using a standardized feeding protocol were noted. Success rate of insertion was 78% and feeding could be established. This method reduced the delays and risks associated with transportation and dependence on other specialties.

Endoscopic placement of jejunal feeding catheters in critically ill patients by a "push" technique.

Enteral nutrition is less expensive and often preferred to parenteral nutrition in the critically ill or injured patient. Gastric feedings are poorly tolerated in some patients, however, and postpyloric access is frequently difficult to obtain. In this report, we describe our experience with a new technique for bedside endoscopic placement of small intestinal feeding tubes. Using both prospective and retrospective analysis, we studied our results with endoscopically placed postpyloric feeding tubes in intensive care unit (ICU) patients. In this method, a 7F nasobiliary tube is passed via an endoscope into the proximal small bowel by a "push" technique. We recorded the demographic data of the patients, the feeding regimens subsequently used for these patients, and the overall feasibility and complications of the procedures themselves. The technique was performed on 71 occasions in 61 ICU patients. The entire procedure averaged 29 minutes in a prospectively evaluated subset of patients. Small intestinal cannulation was successful in every case, including cases in which fluoroscopic attempts had failed. No complications developed from placement of the feeding tubes. This report demonstrates that our bedside method of endoscopic placement of proximal small-bowel feeding tubes may be safely and expediently performed in ICU patients. Although not yet formally compared with other techniques, this procedure may have some advantages over traditional methods of small-bowel feeding tube placement.