NATURAL HISTORY AND RISK FACTORS OF BEDSIDE PERCUTANEOUS ENDOSCOPIC GASTROSTOMY TUBES IN THE ICU
Dix M, Chau LC, Soheim R, Obeid N, Gupta AH, and Stanton C. NATURAL HISTORY AND RISK FACTORS OF BEDSIDE PERCUTANEOUS ENDOSCOPIC GASTROSTOMY TUBES IN THE ICU. Crit Care Med 2023; 51(1):409.
Crit Care Med
INTRODUCTION: There is a paucity of literature describing patients receiving bedside placed percutaneous endoscopic gastrostomy (PEG) tubes in an intensive care unit (ICU) setting. This study aims to describe the natural history, and risk factors for complications for ICU patients requiring bedside PEG tube placement in a Level I trauma center.
METHODS: Adult patients with bedside placed PEG tubes from 1/1/2017 to 1/1/2022 were identified through retrospective chart review. Patients with at least 6 months of follow up were included in this study. Descriptive statistics were used to illustrate the cohort's natural history. Multivariable logistic regression models adjusting for patient demographics, comorbidities, and index hospitalization factors were fitted to identify risk factors predictive of 6-month all cause complications. Major complications were those requiring invasive intervention.
RESULTS: 144 patients were included in this study. Pertinent cohort characteristics include mean age 55.8 years (IQR: 45.6-68.2), 63.9% male sex, 54.9% black race, 28.7% had prior inpatient hospitalization in the past 6 months, 43.4% were transferred from outside hospitals. The most common indications were respiratory failure (31.9%) and blunt trauma (22.9%). The 6-month rate of all-cause and major complication rates were 12.5% and 7.6%, respectively. The most common complications following bedside PEG tube placement were tube dislodgement (44.4%) and surrounding organ injury (27.7%). No deaths associated with PEG tube placement in our study. Bedside PEG tubes were placed on hospital day 15.4 [IQR: 9.7-20.7] and total hospital stay was 34.6 days [IQR: 21.6-43.7]. The most common disposition was to long-term care facility (55.6%). Significant risk factors associated with 6-month all-cause complications include history of diabetes (OR: 5.8, P = 0.038 [95% C.I. 1.1-30.1]). Risk factors for 6-month major complications include prior hospitalization (OR: 5.9, P = 0.05, [95% C.I. 1.01-34]), and increasing serum creatinine (OR: 5.8, P = 0.02, [95% C.I. 1.3-26.6]).
CONCLUSIONS: History of diabetes, prior hospitalization, and elevated serum creatinine were associated with increased rates of 6-month complications among ICU patients receiving bedside PEG tubes in our cohort.