To compare a blind manual bedside method for placing feeding tubes into the small bowel vs. a sonographic bedside technique in critically ill patients. Prospective study with a random sample. Multidisciplinary intensive care unit in a tertiary care university hospital. Thirty-five adult patients. All patients were hemodynamically stable, mechanically ventilated, and required a nasoenteric tube placement for short-term enteral feeding due to impaired gastric emptying. A well-known, blind, manual, bedside method for postpyloric tube placement was always attempted first in all cases. The technique was considered successful when a postpyloric location of the tip of the tube was achieved as shown by abdominal roentgenogram. However, if after 30 mins we failed to enter the small bowel, a radiologist attempted a sonographic bedside technique for postpyloric tube insertion. Finally, when the feeding tube was in place, before starting enteral nutrition, a nasogastric tube was inserted into the stomach. The blind manual method was successful in nine (25.7%) of the 35 patients and the final location of these feeding tubes was the proximal jejunum. The average time for placement of the feeding tubes with this manual technique was 13.9 +/- 7.4 mins (range 5 to 30). The sonographic technique was successful in 22 (84.6%) of the remaining patients and the final location of the feeding tubes was three (11%) tubes in the second portion of the duodenum, eight (31%) tubes in the third portion of the duodenum, and 11 (42%) tubes in the proximal jejunum. The average time for placement with the sonographic technique was 18.3 +/- 8.2 mins (range 5 to 35). The pyloric outlet was sonographically akinetic or severely hypokinetic in 13 patients, and in four of them, we were unable to achieve postpyloric tube placement. In these four patients, the tubes were subsequently placed by endoscopy. The sonographic bedside technique for placing feeding tubes into the small bowel in critically III patients has a success rate of 84.6% (confidence interval 71% to 98%) after the failure of the blind bedside manual method, proving that the former is significantly more successful. This sonographic technique facilitates the insertion of the tubes in patients who cannot be moved and in those patients with severe impairment of the peristaltic activity of the stomach.

Compare the degree of family satisfaction of patients admitted to our intensive care unit (ICU) with the perception of the professional on the care setting and information received. Prospective, descriptive study during 3 months. ICU of the University Hospital Insular of the Canary Islands. Family of adult patients admitted to the ICU who were discharged to the ward and the professionals who treated them. Personal survey to direct family members of the patients when they are in the ward. The same survey, but modified for the professional, was used on the perception that they believed the family had. VARIABLES OF PRINCIPAL INTEREST: Demographic data of the patient, family, and professional interviewed were collected and they were asked questions on the environmental conditions, relationship and quality of the information by the staff and the organization of the visits. A total of 52 family members and 69 staff members were interviewed. The professional overestimated the needs of the family members in regards to noise, lighting, comfort, privacy, adequacy of the waiting room and information on the care received. The professional, on contrary to the family, thought that they were adequately informed about the apparatuses used and that they knew the name of the nurse. Both groups coincided that they knew the name of the doctors, that they were informed of the situation on admission, that the visiting hours were adequate, that more than 2 family members could go into the box and that they were more comfortable if they could be sitting down. Satisfaction of the family was greater than that of the professional interviewed. We stress the need to improve the waiting room, personalized care and the need to individually evaluate flexibility in the visiting hours.

Int J Crit Illn Inj Sci, Official publication of International Network of Critical Illness and Injury Trial Experts,USA