Experiences of Percutaneous Endoscopic Gastrostomy in our Neurology Intensive Care Unit Patients

Levent Öcek; Özge Öcek; Nurullah Damburacı

doi:10.4274/tnd.2019.06745

Levent Öcek¹, Özge Öcek², Nurullah Damburacı³

¹Usak University Faculty of Medicine, Department of Neurology, Usak, Turkey
²Usak University Training and Research Hospital, Department of Neurology, Usak, Turkey
³Usak University Faculty of Medicine, Department of General Surgery, Usak, Turkey

Keywords: Neurology intensive care unit, percutaneous endoscopic gastrostomy, enteral nutrition

Abstract

Objective: Nutritional support has significant clinical importance in patients with poor or no oral intake admitted to neurology intensive care units (NICU). Requirement for, administration methods, and benefits of active enteral feeding with feeding tubes remain a matter of dispute, particularly with respect to patients with impaired swallowing function following central nervous system involvement. In this study, we evaluated the patient characteristics and percutaneous endoscopic gastrostomy (PEG)-related problems in a group of patients in the NICU

Materials and Methods: Patients undergoing PEG and admitted to our NICU between May 2016 and March 2018 were retrospectively examined. Age, sex, duration of NICU stay, need for mechanical ventilation, occurrence of pneumonia, and PEG-related complications were recorded.

Results: A total of 789 patients admitted to the NICU were screened. PEG use was identified among 41 (5.2%) of these patients, of whom 23 (56.1%) were female, with a mean age of 73.66±17.67 (range: 32-94) years. Twenty-nine (70.7%) of these patients with PEG use were diagnosed as having an ischemic etiology, and 7 (17.1%) had hemorrhagic cerebrovascular disease. The mean duration of NICU stay was 48.8±30.6 (range: 13-150) days. On average, PEG was used 29.12±7.97 (range: 13-42) days after admission. Twelve patients (29.3%) received mechanical ventilation, and 8 (19.5%) required a tracheostomy due to prolonged mechanical ventilator support. Prior to PEG, 25 (61.4%) patients had a diagnosis of pneumonia, and 15 (36.6%) patients developed pneumonia after PEG. PEG-associated nutritional intolerance developed in five (12.2%) patients.

Conclusion: In agreement with the published literature, PEG-related complications were low in frequency and there were no cases of PEG-related mortality. In neurologic conditions associated with chronic and severe sequela requiring long-term nutritional support, PEG may be preferred on the basis of its ability to provide safe and physiologic nutrition, ease of use, and a low rate of complications.