While the benefits of tight glycemic control have not been definitive, there are patients who will receive insulin infusion therapy, and the suggestions in this article provide the structure for safe and effective use of this therapy.

Background The helpfulness of bedside assessment of gastric residual volume in the prediction of aspiration has been questioned, as has the volume that signals increased risk of aspiration. Objective To describe the association between gastric residual volumes and aspiration of gastric contents. Methods In a prospective study of 206 critically ill patients receiving gastric tube feedings for 3 consecutive days, gastric residual volumes were measured with 60-mL syringes every 4 hours. Measured volumes were categorized into 3 overlapping groups: at least 150 mL, at least 200 mL, and at least 250 mL. Patients were categorized as frequent aspirators if 40% or more of their tracheal secretions were positive for pepsin and as infrequent aspirators if less than 40% of their secretions were positive for pepsin. Gastric residual volumes were compared between the 2 aspiration groups. Results Approximately 39% of the 206 patients had 1 or more gastric residual volumes of at least 150 mL, 27% had 1 or more volumes of at least 200 mL, and 17% had 1 or more volumes of at least 250 mL. Large-bore tubes identified most of the high volumes. Eighty-nine patients were frequent aspirators. Volumes less than 150 mL were common in both aspiration groups. However, the frequent aspirators had a significantly greater frequency of 2 or more volumes of at least 200 mL and 1 or more volumes of at least 250 mL. Conclusions No consistent relationship was found between aspiration and gastric residual volumes. Although aspiration occurs without high gastric residual volumes, it occurs significantly more often when volumes are high.

Background: To determine if a previously described protocol for small bowel feeding tube (SBFT) placement would be feasible for use in SurgicaUtraund burn intensive care population; if limiting the number of -professionals placing the tubes would achieve a sufficient success rate for cost effectiveness; and to determine the effectiveness of a certified nutrition support dietitian (CNSD)/clinical nurse specialist (CNS) team approach to tube placement. Alefltod: Prospective trial of bedside small bowel feeding tube placement by a CNSENSD team. The setting was a n university-affiliated surgicaUtrauma/burn intensive care unit. A total of 74 patients were included i n the study. Results: We successfully placed 64 of 74 (86.4%) SBFTs in our intensive care unit. The CNS successfully placed 32 of 38 tubes and the CNSD placed 32 of 36 tubes. Of the successfully placed tubes 41 (64%) were at or beyond the ligament of Treitz. Of the other 23 (36%)) 6 were in the second portion of the duodenum, 12 were in the third portion of the duodenum and 5 were in the fourth portion of the duodenum. Of physicians and nurses surveyed, 100% were more satisfied with bedside SBFT placement us fluoroscopy SBFT placement. Conclusions:Successful bedside placement of SBFT in a surgical/ traumdburn intensive care setting by a CNSDENS team approach is a feasible cost effective alternative to fluoroscopy SBFT placement.