Other supportive care
BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7203.175 (Published 17 July 1999) Cite this as: BMJ 1999;319:175All rapid responses
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I am not sure that enteral nutrition has been shown to be equally as
effective as ranitidine or sucrulfate in the prevention of
gastrointestinal bleeding associated with stress ulceration. While I
personally agree with the authors and rarely prescribe specific agents for
stress ulcer prophylaxis in those critically ill patients who have been
established on enteral nutrition via the nasogastric route, this is not an
"evidence based" practice. Indeed, the large Canadian study of Cook et al
to which the authors allude found no effect of enteral nutrition on the
liklihood of bleeding in either group of patients. But I don't believe
they were looking and their analysis was post-hoc and retrospective Given
that physicians feel uncomfortable about withholding enteral nutrition for
any more than 5 to 7 days, it is difficult to think of how a study could
be designed to investigate this issue.
Competing interests: No competing interests
Importance of position of eye lid
Editor- We read the article' ABC of intensive care- Other supportive
care' 1with interest and agree that most effective measures for exposure
keratopathy are preventive. We would like to emphasise that the single
most important observation to be made by ICU staff is the position of the
eye lid2. If there is corneal exposure taping the lid with Micropore is
preferable to other measures as it allows eyelid assessment under closure
because of its transparency.
Our own observations also suggest frequent application of artificial
tear eye drops are not necessary if the lids are completely closed, but
may be helpful if there is conjunctival exposure. As conjunctival oedema
encourages bacterial contamination3 efforts should be taken to reduce its
occurrence without compromising the settings of the vital life supporting
machines. Care needs to be exercised while suctioning is performed for
copious respiratory secretions as it can cause bacterial dispersion and
contamination of the conjunctival sac4. It has been recommended that the
eye be covered and the catheter not withdrawn across the face after
suctioning4.
The presence of redness, discharge and white lesions on the cornea should
alert the staff to seek urgent ophthalmic opinion.
P Suresh, Specialist Registrar.
A Morton, Consultant Anaesthetist.
AB Tullo, Consultant Ophthalmologist.
Manchester Royal Eye Hospital, Oxford Road, Manchester. M13 9WH
1. Adam S, Forrest S. ABC of intensive care-Other supportive care.
BMJ 1999; 319: 175
2. F Mercieca, P Suresh, A Morton, AB Tullo. Ocular surface diseases
in intensive care unit patients. Eye 1999; 13: 231-6.
3. Dua HS.Bacterial keratitis in the critically ill and comotose
patient. Lancet 1998; 351:387-8
4. Hilton E, Uliss A, Samuels S, Adams AA et al. Nosocomial bacterial
eye infections in Intensive care units. Lancet 1983;1:1318-20.
Competing interests: No competing interests