Background: Current guidelines recommend early enteral nutrition in the critically ill. Nutritional deficiencies in this population may result in unfavorable outcomes. However, enteral nutrition may be complicated with feeding intolerance, aspiration, pneumonia, and interruption of feeding. Objectives: We updated our systematic review and meta-analysis that compared the effect of postpyloric and gastric feeding on risk of pneumonia, duration of mechanical ventilation (MV), Intensive Care Unit (ICU) length of stay (LOS), gastrointestinal (GI) bleeding, aspiration, vomiting, and mortality. Methods: We searched MEDLINE, EMBASE, and clinical registries for data through April 2017 without language or date of publication restrictions. We included randomized controlled trials (RCTS) comparing postpyloric feeding to gastric feeding. Two reviewers independently screened titles and abstracts for eligibility and extracted data in duplicate. Reviewers used the Cochrane Collaboration tool to assess the risk of bias, and the Grading of Recommendations, Assessment, Development, and Evaluation methodology to assess the quality of the evidence. We used trial sequential analysis (TSA) as a sensitivity analysis to adjust for sequential testing. Results: We included 21 RCTs (1573 patients). Postpyloric feeding reduced the risk of nosocomial pneumonia (relative risk [RR] 0.73; 95% confidence interval [CI] 0.57, 0.95; P = 0.02; I² = 11%; moderate quality), ventilator-associated pneumonia (RR 0.74, 95% CI 0.57, 0.96; P = 0.02; I² = 10%, moderate quality), and duration of MV (mean difference [MD] - 2.10 days, 95% CI −3.93, −0.28; P = 0.02; I² = 67%, low quality), compared to gastric feeding. There was no difference in mortality (RR 1.07, 95% CI 0.90, 1.27; P = 0.44; I² = 0%, moderate quality), ICU LOS (MD - 1.01 days, 95% CI −3.32, 1.3; P = 0.39; I² = 84%, very low quality), aspiration (RR 0.81, 95% CI 0.4, 1.60, P = 0.54; I² = 21%, very low quality), vomiting (RR 0.97, 95% CI 0.70, 1.36, P = 0.87; I² = 33%, very low quality), and GI bleeding (RR 0.88, 95% CI 0.56, 1.38; P = 0.56; I² = 0%, very low quality). Sensitivity analysis using TSA mirrored those of conventional analyses. Conclusions: Moderate quality evidence showed that postpyloric feeding may reduce the risk of pneumonia. Low-quality evidence yielded that duration of MV is shorter with pyloric compared to gastric feeding, with no significant impact on other outcomes. Although the results are promising further assessment in large clinical trials is warranted.

Background: There is a wide range of conditions requiring a patient to have tracheostomy tube insertion. The use of tracheostomy tubes in hospitals has increased among patients with both stable and critical conditions. Respiratory illness may make it necessary for patients to have an alternative breathing system (apart from the mouth or nose) whether as a temporary or permanent procedure. Patients have different experiences of tracheostomy tube insertion. Aims: This study aims to perform a systematic review of qualitative research into the experiences of patients treated with a tracheostomy tube. Objective: The objective of this study is to systematically appraise qualitative evidence on the experience of adult patients having a tracheostomy tube in situ. The report seeks to answer the following question: What are the experiences faced by adult patients with a tracheostomy tube in situ? Inclusion Criteria: Types of Participants: This review included any research that used qualitative methods to investigate the experiences of adult patients with tracheostomy tube insertion. Phenomenon of Interest: The phenomenon of interest was the experience of patients with a tracheostomy tube in situ either as a temporary or permanent procedure, either in hospital or in the community. Types of Studies: This review deliberated on studies that concentrated on qualitative data. The review included all study designs; for instance, phenomenology, action research, grounded theory, feminist research, and ethnography. Search Strategy: The review included all relevant studies published in Arabic and English obtained from the following databases: CINAHL, Cochrane Library, EMBASE, MEDLINE (PubMed), and Scopus and reference lists. There was no limitation on year of publication, and reference list items were searched along with keywords in the heading, abstract, and topic descriptors. Methodological Quality: The methodological quality of each study was assessed by applying the Joanna Briggs Institute's Qualitative Assessment and Review Instrument. Data Collection: The study included adult patients treated with a tracheostomy tube. The research literature was searched using the standard methodology of qualitative research. The two reviewers then applied inclusion and exclusion criteria to the studies and evaluated the findings that met the inclusion criteria on the same subject. Data Synthesis: Synthesis of all data enabled a statement to be created that explains the experiences of adult patients with a tracheostomy tube in situ in the hospital or community. The data were then characterized according to the quality of findings and the similarity of meaning. Results: Four studies met the study selection criteria and were included in the systematic review that determined the experience of patients with a tracheostomy tube in situ. There were 18 findings extracted from the included studies. These were synthesized and then grouped into seven categories in relation to similarity of meaning. The seven categories remaining were then synthesized in a meta-synthesis that produced four outcomes linked to the experiences of participants having a tracheostomy tube in situ: (i) Communication is fundamental. (ii) The experience has both physical and psychological impacts. (iii) There are long-term consequences. (iv) Staff and patients work together to achieve positive outcomes. Conclusions: In the studies appraised by the reviewers, the importance of understanding the experiences of adult patients with tracheostomy tubes in situ was clarified. Patients have a right to experience correct practices that may help them to adapt to a new lifestyle with a tracheostomy. Implications for Practice: Patients should be given support physically, psychosocially, and emotionally after tracheostomy tube insertion. In addition, nurses' awareness about patients' educational needs regarding tracheostomy care, before discharge from hospital, needs to be increased. Implications for Further Research: Further research is required to identify the ways to reduce patients' negative experiences after having a tracheostomy tube in situ.

High-flow oxygen therapy is a novel technology in the treatment of hypoxemic respiratory failure (HRF). The effect in neonatal and pediatric population is well known, but its efficiency in the adult patient group is not well proven. This review tried to discuss various aspects of high-flow nasal cannula (HFNC) in terms of its components, effects, and the evidence available. High-flow nasal cannula is being used as the first choice of intervention in patients with acute HRF, especially in patients who does not have critical hypercapnia. Clinicians should be very selective while choosing the adult patients for HFNC.

Non-invasive ventilation (NIV) refers to the use of ventilator support by delivering a pressurized gas via external facial interfaces. NIV is commonly used by clinicians to avoid intubation and the risks associated with invasive positive mechanical ventilation. NIV has recently become an integral tool in the management of acute conditions and chronic respiratory failure. This therapeutic modality is well recognized in selected patients with acute respiratory failure (ARF) related to exacerbation of chronic obstructive pulmonary disease, acute cardiogenic pulmonary edem and immunocompromised states. Several studies have shown that NIV play a crucial role in reducing the need for endotracheal intubation, length of hospitalization, morbidity and mortality. It is also used as a prophylactic interventional tool in post-extubation patients to prevent re-intubation cases. A patient at high risk of re-intubation may benefit from NIV application; however, close monitoring is essential to detect any indicative signs of extubation failure.

Ventilation in critical care areas is crucial in minimizing surgical site infection, this article review the two ventilation modules used in operating rooms and based on previous studies conclude that hospitals should continue using the classical ventilation.

Background: With the rapid increase of smartphone usage worldwide for health care and fitness, developing applications for identify different types of medicines are deemed necessary. Pills are difficult to be identified, especially if they are without their package or prescription. Objective: The objectives of the study were to design and develop a mobile application for identifying unrecognized narcotic and controlled pills. Methods: For initial designing, we used the drawing features in Microsoft Office software. For development, we began developing an innovative, novel iOS and Android application. To accomplish this stage, the application features an array of possible identification characteristics. This application has been developed by image processor using compatible application; as the application has been loaded with all the opioid pills pictures that are available in Saudi Arabia along with their details to identify these pills. Results: We successfully developed a new and innovative mobile application to identify narcotic and controlled pills called “controlled and narcotic pill identifier (CNPI)”. With this newly CNPI application, the target user is able to identify the pills simply by taking pictures of medication pills from both sides and/or answering a couple of questions about the pills such as shape, color, and imprint. The initial testing proved feasibility, acceptability, and practicability of the application. Conclusion: To our knowledge, this is the first mobile application developed for rapidly identifying the narcotic and controlled pills in different settings which is useful for clinicians and patients, as well as government officials.