Solunum Yoğun Bakım Ünitesinde Perkütan Endoskopik Gastrostominin Klinik Sonuçları

Year 2023, Volume: 13 Issue: 5, 782 - 785, 30.09.2023

Kamuran Uluç Esra Akkütük Öngel Nazan Köylü İlkaya Özkan Devran Ernur Ay Hatice Kutbay Özçelik

https://doi.org/10.16899/jcm.1331937

Abstract

Amaç: Perkütan endoskopik gastrostomi (PEG), 2-3 haftadan daha uzun süreli enteral beslenmeye ihtiyaç duyması beklenen hastalarda kullanılan beslenme yöntemidir. Yoğun bakım ünitemizde takip ettiğimiz ve beslenmelerini PEG açarak sağladığımız hastalarda PEG endikasyonlarını, komplikasyonlarını ve işlem sonrası hasta prognozlarını değerlendirmeyi amaçladık.
Gereç ve Yöntem: Hastanemiz Solunum Yoğun Bakım Ünitesinde 1 Ocak 2017 – 31 Aralık 2022 tarihleri arasında PEG uyguladığımız 51 hastayı retrospektif olarak incelendi.
Bulgular: PEG uygulanan hastaların 30’u (%58) erkekti. Hastaların yaş ortalaması 63,9 (min 23-max 90)du. Hastaların Glasgow koma skalası (GKS) ortalaması 8,47, Akut Fizyoloji ve Kronik Sağlık Değerlendirme II (APACHE II) skoru ortalaması 22, Sepsis İlişkili Organ Yetmezliği Değerlendirmesi (SOFA) skoru ortalaması 7,45, PEG açılma günü ortalaması 24,8, yoğun bakım yatış gün ortalaması 48,8 di. Hastaların 21’ine (%41,2) Serobrovasküler hastalık( SVH), 19’una (%37,3) Alzhemier/ Demans/ Parkinson , 18’ine (35,3) uzamış mekanik ventilasyon nedeniyle PEG açıldı. PEG komplikasyon oranı %13,7 idi. PEG açılan hastaların 35’i (%68,6) taburcu, 16’sı (%31,4) exitus oldu.
Sonuç: Hasta başında kolayca uygulanabilmesi, komplikasyon ve mortalite oranlarının son derece az olması nedeniyle özellikle oral alımı yeterli olmayan yoğun bakım hastalarında enteral tedavilerin sürdürülebilmesi için PEG takılması uygundur.

Keywords

Perkütan endoskopik gastrostomi, yoğun bakım ünitesi, endikasyon ve komplikasyon, prognoz, nutrisyon

Clinical Outcomes of Percutaneous Endoscopic Gastrostomy in the Respiratory Intensive Care Unit

Abstract

Aim: Percutaneous endoscopic gastrostomy (PEG) is a feeding method used in patients who are expected to require enteral nutrition for more than 2-3 weeks. We aimed to evaluate PEG indications, complications, and post-procedural patient prognosis in patients followed up in our intensive care unit and fed via PEG.
Materials and Methods: We retrospectively reviewed 51 patients receiving PEG between January 1, 2017, and December 31, 2022, in the Respiratory Intensive Care Unit.
Results: Among the patients receiving PEG, 30 (58%) were male. The average age was 63.9, ranging from 23 to 90. The mean scores for the Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Sepsis Related Organ Failure Assessment (SOFA) were 8.47, 22, and 7.45, respectively. The mean duration until PEG placement was 24.8 days, and the average intensive care unit (ICU) hospitalization was 48.8 days.PEG was performed in 21 patients (41.2%) due to cerebrovascular disease, in 19 patients (37.3%) due to Alzheimer, dementia, or Parkinson's disease, and 18 patients (35.3%) due to prolonged mechanical ventilation. The complication rate associated with PEG was 13.7%. Among the patients who underwent PEG, 35 (68.6%) were discharged, while 16 (31.4%) died.
Conclusion: Considering its easy use at bedside, low complication, and mortality rates, PEG insertion is appropriate for continuing enteral therapies, especially in intensive care patients with insufficient oral intake.

Keywords

Percutaneous endoscopic gastrostomy, intensive care unit, indications and complications, prognosis, nutrition

References

• 1. Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: a systematic review. Critical Care Medicine 2001;29(12):2264-70.
• 2. Alverdy J, Chi HS, Sheldon GF. The effect of parenteral nutrition on gastrointestinal immunity. The importance of enteral stimulation. Ann Surg 1985;202(6):681-4
• 3. Nicholson FB, Korman MG, Richardson MA. Percutaneous endoscopic gastrostomy: a review of indications, complications and outcome. Journal of Gastroenterology and Hepatology 2000;15(1):21-5.
• 4. Löser C, Aschl G, Hébuterne X, Mathus-Vliegen EMH, Muscaritoli M, Niv Y, et al. ESPEN guidelines on artificial enteral nutrition - Percutaneous endoscopic gastrostomy (PEG). Clinical Nutrition 2005;24(5);848-61
• 5. Gauderer MWL, Ponsky JL, Izant RJ. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 1980;15(6):872-5.
• 6. Friginal-Ruiz AB, González-Castillo S, Lucendo AJ. Endoscopic percutaneous gastrostomy: an update on the indications, technique and nursing care. Enferm Clin 2011;21(3):173-8.
• 7. Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. Journal of Parenteral and Enteral Nutrition 2003;27(5):355-73.
• 8. Bechtold ML, Matteson ML, Choudhary A, Puli SR, Jiang PP, Roy PK. Early versus delayed feeding after placement of a percutaneous endoscopic gastrostomy: a meta-analysis. American Journal of Gastroenterology 2008;103(11):2919-24.
• 9. Tokunaga T, Kubo T, Ryan S, Tomizawa M, Yoshida SI, Takagi K, et al. Long-term outcome after placement of a percutaneous endoscopic gastrostomy tube. Geriatr Gerontol Int 2008;8(1):19-23.
• 10. McClave SA, Lukan JK, Stefater JA, Lowen CC, Looney SW, Matheson PJ, et al. Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients. Crit Care Med 2005;33(2):324-30.
• 11. Arvanitakis M, Gkolfakis P, Despott EJ, Ballarin A, Beyna T, Boeykens K, et al. Endoscopic management of enteral tubes in adult patients - Part 1: Definitions and indicationsEuropean Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021;53(1);81-92.
• 12. Tok D, Ok G, Erbüyün K, Ertan Y, Çetin İ. Yoğun Bakım Ünitesinde Perkutan Endoskopik Gastrostomi Uygulamaları. Dicle tıp dergisi 2006;33(2):81-4
• 13. Çelik J, Sizer Ç, Yosunkaya A, Küçükkartallar T. Perkütan endoskopik gastrostomi (peg) deneyimlerimiz: 68 olgu nedeni ile. Selçuk Tıp Dergisi 2009;25(1):37-42.
• 14. Duzenli T, Ketenci M, Akyol T, Koseoglu H, Tanoglu A, Kaplan M, et al. Predictive factors of complications and 30-day mortality in patients undergoing percutaneous endoscopic gastrostomy: the utility of c-reactive protein to albumin ratio. Acta Gastroenterol Belg 2021;84(2):283–8.
• 15. Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, et al. Updating and validating the charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 2011;173(6):676-82.
• 16. Kartal M, Kalaycı T, Yeni M. Üçüncü Basamak Bir Sağlık Merkezinin Perkütan Endoskopik Gastrostomi Deneyimi. Cukurova Anestezi ve Cerrahi Bilimler Dergisi 2022;5(1):54-60.
• 17. Civan HA, Bektas G, Dogan AE, Ozdener F. Percutaneous Endoscopic Gastrostomy Feeding in Children with Cerebral Palsy. Neuropediatrics 2021;52(4):326-332.
• 18. Sleigh G, Brocklehurst P. Gastrostomy feeding in cerebral palsy: a systematic review. Archives of Disease in Childhood 2004;89(6):534-539.
• 19. Grandidge L, Chotiyarnwong C, White S, Denning J, Nair KPS. Survival following the placement of gastrostomy tube in patients with multiple sclerosis. Mult Scler J Exp Transl Clin. 2020;6(1).
• 20. Gomes CA, Andriolo RB, Bennett C, Lustosa SA, Matos D, Waisberg DR, et al. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances. Cochrane Database of Systematic Reviews 2015;2015(5).
• 21. Grant MD, Rudberg MA, Brody JA. Gastrostomy placement and mortality among hospitalized Medicare beneficiaries. JAMA 1998;279(24):1973-6.
• 22. Gauderer MWL. Percutaneous endoscopic gastrostomy: a 10-year experience with 220 children. J Pediatr Surg 1991;26(3):288-92.
• 23. Ermis F, Ozel M, Oncu K, Yazgan Y, Demirturk L, Kemal Gurbuz A, et al. Indications, complications and long-term follow-up of patients undergoing percutaneous endoscopic gastrostomy: a retrospective study. Wien Klin Wochenschr 2012;124(5–6):148-53.
• 24. Hossein SM, Leili M, Hossein AM. Acceptability and outcomes of percutaneous endoscopic gastrostomy (PEG) tube placement and patient quality of life. Turkish Journal of Gastroenterology 2011;22(2):128-33.
• 25. Panigrahi H, Shreeve DR, Tan WC, Prudham R, Kaufman R. Role of antibiotic prophylaxis for wound infection in percutaneous endoscopic gastrostomy (PEG): result of a prospective double-blind randomized trial. Journal of Hospital Infection 2002;50(4):312-5.
• 26. Ahmad I, Mouncher A, Abdoolah A, Stenson R, Wright J, Daniels A, et al. Antibiotic prophylaxis for percutaneous endoscopic gastrostomy – a prospective, randomised, double-blind trial. Aliment Pharmacol Ther 2003;18(2):209-15.