Gastrointestinal endoscopy clinics of North America
-
Gastrointest. Endosc. Clin. N. Am. · Oct 2008
ReviewProviding safe sedation/analgesia: an anesthesiologist's perspective.
Over the past several years office-based procedures with sedation have become increasingly more common. It must be appreciated that not all procedures are well suited for this type of environment. ⋯ Since esophagogastroduodenoscopy (EGD) and colonoscopy are relatively non-invasive, of short duration, and not associated with either fluid shifts or significant post-procedure discomfort. In appropriate patients, these procedures are well-suited to office-based practice.
-
Gastrointest. Endosc. Clin. N. Am. · Oct 2007
ReviewDecreasing aspiration risk with enteral feeding.
Aspiration is a clinical concern in patients receiving enteral tube feeding. Aspiration can result in pneumonia leading to increases in the use of antibiotics, length of hospital stay, and the risk of mortality. Pneumonia caused by aspiration of gastric contents is of particular concern in patients who require mechanical ventilation and feeding by nasogastric tube. This article summarizes factors that might influence the development of aspiration pneumonia and minimize risk, such as the position of the patient's body, method of feeding, and size of the feeding tube.
-
Gastrointest. Endosc. Clin. N. Am. · Oct 2007
ReviewHow many calories are necessary during critical illness?
Several nutritional alternatives exist to provide critically ill patients sufficient calories to meet metabolic demands. Intuitively, investigators, nutritionists, and clinicians have pursued the goal of providing high-calorie nutrition support, believing that this would improve outcomes. There is little evidence, however, that meeting caloric goals is of significant benefit. ⋯ This suggests that permissive underfeeding could replace the paradigm of meeting measured caloric goals. Prospective evidence to support adoption of permissive underfeeding is lacking, however. Appropriate clinical studies are necessary to prove its safety and efficacy.
-
Feeding into the small bowel is often recommended to improve nutrient delivery for critically ill patients, and thus improve outcome and reduce complications associated with enteral feeding. Risks and benefits of gastric feeding, use of motility agents, postpyloric feeding, and obtaining small bowel access are discussed here. ⋯ Current evidence does not support routine use of postpyloric feeding in the critically ill. A standardized approach to optimizing benefits and minimizing risks with enteral nutrition delivery will help clinicians identify patients who would benefit from small bowel feeding.
-
Gastrointest. Endosc. Clin. N. Am. · Oct 2007
ReviewDecisions to be made when initiating enteral nutrition.
Enteral nutrition support is preferred to parenteral or no nutritional support, but many patients who could benefit receive inadequate enteral feeding. Many decisions must be made before initiating enteral nutrition support; including if and when enteral nutrition should be started, which formula should be used, and how enteral nutrition support should be monitored. The gastroenterologist should be able to understand and evaluate these decisions in all patients potentially requiring nutritional support.