Erişkin yoğun bakım ünitesinde perkütan gastrostomi uygulamaları: Retrospektif bir analiz
Date
2021
Authors
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Journal ISSN
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Publisher
Bursa Uludağ Üniversitesi
Abstract
Amaç: Perkütan Endoskopik Gastrostomi (PEG), yetersiz oral alım nedeniyle beslenme ihtiyaçlarını karşılayamayan, fonksiyonel olarak normal gastrointestinal sistem hastalarına etkili bir enteral beslenme yöntemidir. Çalışmamızın amacı, yoğun bakımımızda enteral bir yol olarak PEG deneyimimizi bir araya getirmek ve PEG endikasyonlarımızı ve komplikasyonlarımızı literatür ile karşılaştırmaktır. Yöntem: Bursa Uludağ Üniversitesi Yoğun Bakım Ünitemizde 1 Ocak 2014 - 30 Haziran 2019 tarihleri arasında PEG'nin sonucu ve komplikasyonları retrospektif olarak değerlendirildi. Bulgular: 68 hasta (23 erkek, 45 kadın) çalışmamıza dahil edildi. Ortalama yaş 57.6 ± 19.9 olarak saptandı. PEG için en yaygın endikasyonlar; Travmatik Beyin Hasarı (19/68, % 27.9), Serebrovasküler Hastalık (16/68, % 23.5) ve İskemik Ensefalopati (17/68, % 25) idi. 61 hasta (% 89.7) Nazogastrik Tüp ile enteral yolu ile, 6 hasta (% 8.8) parenteral yolu ile, 1 hasta (% 1.5) her iki yoldan beslenmişti. Ortalama hastanede kalış süresi 94,5 ± 64,3 gündü, yatışın ortalama 45.6±30.1 gününde PEG açılmıştı. 8 hastaya (% 11.8) profilaktik olarak 1 doz antibiyotik uygulanmıştı, 27 hasta (% 39.2) devam eden enfeksiyonlar nedeniyle antibiyotik kullanıyordu, 33 hasta (% 48.5) antibiyotik kullanımı yoktu. PEG açıldıktan ortalama 13.5±12.4 saat (3-72 saat) sonra beslenmeye başlanmıştı. 5 hastada işleme bağlı komplikasyonlar görülmüş, 3 hastada (% 4.4) çoklu girişimler, bir hastada (% 1.5) klinik olarak anlamlı olmayan mikroperforasyon ve bir hastada (% 1.5) mide perforasyonu görülmüş, bu hasta beslenme başladıktan hemen sonra genel durumu bozulmuş, vasopresör ihtiyacı olmuş, antibiyotik başlanmış, genel cerrahi tarafından ameliyat edilmiş, tam iyileşme sağlanmıştı. Minör komplikasyon toplamda 11 hastada (% 13.2) görülmüş, 5 hastada (% 7.4) giriş noktası çevresinde sızıntı, 3 hastada (% 4.4) giriş çevresinde enfeksiyon, 1 hastada (% 1.5) tüp yerinden çıkma, 1 hastada tüpte yırtık (% 1.5), 1 hastada (% 1.5) tüp tıkanıklığı görülmüştü. 5 hastada majör komplikasyon, 2 hastada (% 2.9) selülit, 2 hastada (% 2.9) pulmoner aspirasyon, antiplatelet tedavi alan bir iii hastada (% 1.5) müdahale gerektiren hematom görülmüştü. Toplamda12 hasta (% 17.6) PEG ile ilişkili olmayan altta yatan hastalıklar nedeniyle exitus olmuştu. Sonuç: Uzman ellerde PEG, enteral beslenme için güvenli ve etkili bir beslenme yöntemidir, Perforasyon gibi ciddi komplikasyonlarda, işlem sonrası hastaların yakın takibi ve şüphe durumunda hızlı davranılması ölümleri önleyebilir.
Background: Percutaneous Endoscopic Gastrostomy (PEG) is an effective enteral feeding method to patients with functionally normal gastrointestinal tract who cannot meet their nutritional needs because of an inadequate oral intake. The purpose of our study is to report our experience with PEG as an effective enteral route in our intensive care unite and to compare our indications and complications of PEG with those reported in the literature. Methods: The outcome and complications of PEG in our Intesive Care Unit patients of Bursa Uludağ University from the first of January 2014 till 30 june 2019 were retrospectively evaluated. Results: A total of sixty eight patients (23 male, 45 female) were enrolled, with an average age of 57.6 ±19.9 (range, 10–92 years) underwent PEG placement. The most common indications for PEG were Traumatic Brain Injury (19/68, 27.9%), Cerebrovascular Disease (16/68, 23.5%), and Ischemic Encephalopathy (17/68, 25%) 61 patients (%89.7) were fed enterally by Nasogastric Tube, 6 patients (%8.8) were fed by parenteral route and 1 patient (%1.5) was fed by both routes. The mean length of hospital stay was 94.5±64.3 days. The mean time from admission until application of PEG was 45.6±30.1 days. One dosage of antibiotics was administered prophylactically in 8 patients (%11.8), 27 patients (%39.2) were already on antibiotics for ongoing infections, 33 patients (%48.5) did not recieve any antibiotics. After procedure was done, 13,5±12.4 hour was the mean time before enteral feeding was started (range 3-72 hour). Procedure related complications were seen in 5 patients, multiple attempts were seen in 3 of them (%4.4), one patient (%1.5) had clinically nonsignificat micoperforation and a stomach perforation was seen in one patient (1.5%), that patient was deteriorated after feeding had been started, vasopressor drugs and antibiotics were started, he was operated by general surgeon and achieved a full recovery. Minor complication was seen in 11 patients (% v 13.2), leakage around the entery point was seen in 5 patients (%7.4), infection around the entery was seen in 3 patients (%4.4), tube dislodgement was seen in 1 patient (%1.5), tear in the tube was seen in 1 patient (%1.5), occlusion of the tube was seen in 1 patient (%1.5). Major complication was seen in 5 patients, Celulitis was seen in 2 patients (%2.9), Pulmonary Aspiration was seen in 2 patients (%2.9), one patient (%1.5) who was on antiplatelet therapy had a hematoma that necessitated intervention. 12 patients (17.6%) were deceased due to the underlying diseases unrelated to PEG. All the complications were managed well, without any effect on mortality. Conclusion: PEG, in expert hands, is a safe and effective procedure for enteral nutrition. In case of serious complications such as perforation, closed follow up of patients after the procedures and acting fast in case of suspicition can prevent mortality.
Background: Percutaneous Endoscopic Gastrostomy (PEG) is an effective enteral feeding method to patients with functionally normal gastrointestinal tract who cannot meet their nutritional needs because of an inadequate oral intake. The purpose of our study is to report our experience with PEG as an effective enteral route in our intensive care unite and to compare our indications and complications of PEG with those reported in the literature. Methods: The outcome and complications of PEG in our Intesive Care Unit patients of Bursa Uludağ University from the first of January 2014 till 30 june 2019 were retrospectively evaluated. Results: A total of sixty eight patients (23 male, 45 female) were enrolled, with an average age of 57.6 ±19.9 (range, 10–92 years) underwent PEG placement. The most common indications for PEG were Traumatic Brain Injury (19/68, 27.9%), Cerebrovascular Disease (16/68, 23.5%), and Ischemic Encephalopathy (17/68, 25%) 61 patients (%89.7) were fed enterally by Nasogastric Tube, 6 patients (%8.8) were fed by parenteral route and 1 patient (%1.5) was fed by both routes. The mean length of hospital stay was 94.5±64.3 days. The mean time from admission until application of PEG was 45.6±30.1 days. One dosage of antibiotics was administered prophylactically in 8 patients (%11.8), 27 patients (%39.2) were already on antibiotics for ongoing infections, 33 patients (%48.5) did not recieve any antibiotics. After procedure was done, 13,5±12.4 hour was the mean time before enteral feeding was started (range 3-72 hour). Procedure related complications were seen in 5 patients, multiple attempts were seen in 3 of them (%4.4), one patient (%1.5) had clinically nonsignificat micoperforation and a stomach perforation was seen in one patient (1.5%), that patient was deteriorated after feeding had been started, vasopressor drugs and antibiotics were started, he was operated by general surgeon and achieved a full recovery. Minor complication was seen in 11 patients (% v 13.2), leakage around the entery point was seen in 5 patients (%7.4), infection around the entery was seen in 3 patients (%4.4), tube dislodgement was seen in 1 patient (%1.5), tear in the tube was seen in 1 patient (%1.5), occlusion of the tube was seen in 1 patient (%1.5). Major complication was seen in 5 patients, Celulitis was seen in 2 patients (%2.9), Pulmonary Aspiration was seen in 2 patients (%2.9), one patient (%1.5) who was on antiplatelet therapy had a hematoma that necessitated intervention. 12 patients (17.6%) were deceased due to the underlying diseases unrelated to PEG. All the complications were managed well, without any effect on mortality. Conclusion: PEG, in expert hands, is a safe and effective procedure for enteral nutrition. In case of serious complications such as perforation, closed follow up of patients after the procedures and acting fast in case of suspicition can prevent mortality.
Description
Keywords
Perkütan endoskopik gastrostomi (PEG), Endikasyon, Komplikasyon, Mortalite, Percutaneous endoscopic gastrostomy (PEG), Indication, Complication, Mortality
Citation
Alnawajha, A. (2021). Erişkin yoğun bakım ünitesinde perkütan gastrostomi uygulamaları: Retrospektif bir analiz. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.