Gut access in critically ill and injured patients: Where have we gone thus far?

European Surgery (Impact Factor: 0.27). 02/2011; 43(1):24-29. DOI: 10.1007/s10353-011-0590-1


Background: Nutritional support in critically ill and injured patients is crucial. It can be provided via parenteral or enteral access, each of which has advantages and disadvantages. In this article, we review enteral support, particularly gut access. Methods: We conducted a literature review. Results: A number of techniques enable access to the gastrointestinal tract in critically ill and injured patients. A temporary orogastric (OG), nasogastric (NG), or nasojejunal (NJ) feeding tube can be placed. But the prevalent technique is the more permanent percutaneous endoscopic gastrostomy (PEG), which has economic as well as safety benefits. Other techniques include open operative gastrostomy, laparoscopic or laparoscopic-as-sisted gastrostomy, and jejunostomy. Conclusions: Nutritional support should be provided enterally, via gut access whenever possible. The issue of pre- versus post-pyloric access remains controversial. PEG is safe and economical for long-term access.

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    ABSTRACT: As the role of acute care surgery (ACS) becomes more prevalent, clinicians in this specialty will be placing more percutaneous endoscopic gastrostomy (PEG) tubes. In this contemporary series of ACS PEG procedures, we hypothesized that technical aspects of PEG tube placement may play an important role. For our retrospective study, we queried our tertiary Level I trauma center's prospectively maintained ACS database for PEG tube placement. Our study period was from July 1, 2010, through June 30, 2012. We excluded patients who underwent "push" PEG placement, an outpatient PEG tube placement, or an open or laparoscopic gastrostomy tube operation. We conducted a multivariate logistic regression analysis of factors contributing to complications. During our 24-month study period, of 184 patients, 133 underwent "pull" PEG tube placement with sufficient data for analysis. The mean (SD) age was 56 (22) years; 66% were male. Overall, 33 (25%) experienced complications: 13 (10%) were major and 20 (15%) were minor complications. In our multivariate logistic regression analysis, we found that an extreme bumper height (<2 or >5 cm) (odds ratio, 1.57; 95% confidence interval, 1.14-2.16) and upper aerodigestive tract malignancy as the operative indication (odds ratio, 1.54; 95% confidence interval, 1.06-2.26) were significantly associated with complications. Although pull PEG tube placement is typically a straightforward procedure, morbidity can be significant. Bumper height is an easily modifiable variable; obtaining the proper height for each patient could decrease complications after PEG tube placement. Therapeutic study, level IV.
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