Chest
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Review Case Reports
Pleuropulmonary complications of enteral tube feedings. Two reports, review of the literature, and recommendations.
Enteral tube feeding is an attractive alternative to intravenous alimentation for nutritional support. As previously used nasogastric tubes have been replaced with narrow-bore nasogastric tubes, the spectrum of complications seen with these devices has changed. We report a previously undescribed event associated with narrow-bore nasogastric tube feeding, review the literature, noting predisposing factors and complications, and suggest guidelines to avoid pitfalls of insertion and the ensuing adverse effects.
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Breathlessness is a common symptom in patients with respiratory disorders and contributes significantly to functional disability. Recent studies of the psychophysics of respiratory sensation suggest that dyspnea is a function of the forces generated by the respiratory muscles during the act of breathing and may simply represent the intensity of the sense of effort arising from central respiratory motor command signals. It is important to recognize the multidimensional nature of respiratory sensations that include not only sensory aspects but also affective and cognitive components. ⋯ Efforts to minimize abnormalities in ventilatory system impedance are limited by the largely irreversible nature of most chronic lung diseases. Sedatives and narcotic agents have not proved to be effective in altering perceptual responses and may have an adverse effect, worsening respiratory failure. Physical measures to improve overall conditioning and respiratory muscle performance may be most effective in relieving breathlessness and improving exercise capacity in patients with chronic lung disease.
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Diaphragmatic paralysis in patients with respiratory insufficiency compounds the problems in the management. In the presence of lower lobe atelectasis, pleural effusion, or a patient's poor respiratory effort, fluoroscopic examination is often not a reliable way to diagnose diaphragmatic paralysis. ⋯ In 14 postoperative patients and one with cervical spinal cord injury with respiratory failure, we found ten patients who showed phrenic nerve dysfunction. Besides diagnostic utility, the electrophysiologic evaluation of phrenic-diaphragmatic function provides critical information needed for therapy.
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Excess carbohydrate calories in total parenteral nutrition (TPN) solutions can precipitate acute hypercapnic respiratory failure in patients with chronic lung disease secondary to increased carbon dioxide (CO2) production. Two young patients recovering from the adult respiratory distress syndrome experienced hypercapnia during weaning as a result of nutritionally related increased CO2 production. As carbohydrate calories were decreased, CO2 production diminished and hypercapnia resolved. Hypercapnia as a complication of nutritional support during weaning can occur in patients without chronic lung disease and is corrected by decreasing carbohydrate calories.