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Tracheostomies and PEGs: When Are They Really Indicated?
1Department of Surgery, Mission Hospital, Asheville, NC, USA.
The Surgical Clinics of North America
|August 27, 2019
Summary
Surgeons evaluate the appropriateness of tracheostomy and percutaneous endoscopic gastrostomy tubes. This review examines evidence for and against these procedures based on patient prognosis and goals of care.
Area of Science:
- Surgical Procedures
- Medical Ethics
- Patient Care
Background:
- Surgeons frequently consult on tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube placements.
- Consultations require balancing patient-provider relationships with clinical appropriateness.
- Prognosis and goals of care are critical factors in decision-making.
Purpose of the Study:
- To review common indications for tracheostomy and PEG tube placement.
- To analyze evidence supporting or refuting tube placement in various conditions.
- To provide a framework for surgeons discussing these procedures within the context of goals of care.
Main Methods:
- Literature review of conditions requiring tracheostomy and PEG tubes.
- Analysis of evidence for and against tube placement.
- Development of a decision-making framework.
Main Results:
- Identified common conditions necessitating these procedures.
- Summarized supporting and opposing evidence for tube placement.
- Proposed a framework for goal-of-care discussions.
Conclusions:
- Evidence-based assessment is crucial for appropriate tracheostomy and PEG tube recommendations.
- Integrating prognosis and patient goals is essential for ethical surgical consultation.
- The provided framework aids surgeons in complex decision-making.
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