Outcomes of Tracheostomy With Concomitant and Delayed Percutaneous Endoscopic Gastrostomy in the Neuroscience Critical Care Unit
| Autor: | Marek A. Mirski, David H Wu, Romergryko G. Geocadin, Vinciya Pandian, Ravirasmi Jasti, Christa O'Hana S. Nobleza |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Critical Care medicine.medical_treatment Critical Care and Intensive Care Medicine law.invention 03 medical and health sciences 0302 clinical medicine Tracheostomy law Percutaneous endoscopic gastrostomy Medicine Humans In patient Hospital Mortality Aged Retrospective Studies Gastrostomy business.industry Critically ill Neurointensive care 030208 emergency & critical care medicine Middle Aged Intensive care unit Surgery Intensive Care Units Treatment Outcome 030228 respiratory system Concomitant Female Nervous System Diseases business |
| Zdroj: | Journal of intensive care medicine. 34(10) |
| ISSN: | 1525-1489 |
| Popis: | Background:In patients with severe neurologic conditions, percutaneous endoscopic gastrostomy (PEG) is typically performed either alone or with a tracheostomy. The characteristics and outcomes of patients receiving PEG concomitantly with a tracheostomy (CTPEG) and those receiving delayed PEG (DPEG) after a tracheostomy were compared.Methods:Retrospective cohort study in a 24-bed neuroscience critical care unit (NCCU) at a tertiary care hospital. Consecutive patients admitted to the NCCU from April 2007 to July 2013 who underwent percutaneous tracheostomy and gastrostomy by the percutaneous tracheostomy team were included and grouped according to the timing of PEG placement: CTPEG versus DPEG.Results:Of the 290 patients, 234 (81%) received CTPEG. Demographic and clinical characteristics were similar among the 2 groups except for a lower median (interquartile range [IQR]) body mass index (BMI; 27 [22.67-31.60] versus 30.8 [24.55-40.06], P = .017) and lower rate of acute respiratory distress syndrome (3.85% vs 10.71%, P = .048) in the CTPEG cohort. Furthermore, 59% of CTPEG cohort were neurology patients while 63% of DPEG were neurosurgery patients, P = .004. Primary outcomes showed shorter mean NCCU length of stay (LOS; 25 [12] vs 33 [17] days, P < .001) and median hospital LOS (32 [25-43] vs 37 [31-56] days, P = .002) for the CTPEG cohort. Secondary outcomes showed higher predischarge prealbumin levels (15.6 [7.75] vs 11.58 [5.41], P = .021) and lower median overall hospital cost (US$123 860.20 [US$99 024-US$168 713.40] vs US$159 633.50 [US$121 312-US$240 213.10], P = .0003) in the CTPEG group. Anatomic contraindications were the most common reason for DPEG (30%).Conclusions:Among institutions with a tracheostomy team, the practice of tracheostomy with concomitant PEG placement may be considered as feasible as delayed PEG in carefully selected neurocritically ill patients with possible advantages of overall shorter NCCU and hospital LOS, higher predischarge prealbumin, and lower hospital costs. These findings may aid in decisions regarding the timing of PEG placement in the NCCU. Further prospective studies are warranted. |
| Databáze: | OpenAIRE |
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