Related Experiment Videos
Percutaneous endoscopic gastrostomy for patients with severe cerebral injury
W L Akkersdijk1, J A Roukema, C van der Werken
1Department of Surgery, Utrecht University Hospital, The Netherlands.
Insights
Percutaneous endoscopic gastrostomy (PEG) feeding is beneficial for severely injured patients with brain damage, enabling early nutrition. While complications can occur, PEG offers advantages over nasogastric tubes for long-term nutritional support.
Area of Science:
- Trauma surgery
- Intensive care medicine
- Gastroenterology
Background:
- Early enteral nutrition is crucial for improving outcomes in severely injured patients.
- Nasogastric feeding tubes have limitations for prolonged nutritional support.
Purpose of the Study:
- To evaluate the outcomes of enteral nutrition via percutaneous endoscopic gastrostomy (PEG) in severely traumatized patients with major cerebral injury.
Main Methods:
- Retrospective analysis of 24 severely traumatized patients (mean Injury Severity Score = 44) requiring intensive care.
- PEG placement for enteral nutrition, typically 14 days post-admission.
- Data collection on duration of intensive care, hospital stay, and feeding outcomes.
Main Results:
- PEG feeding was administered for a mean of 45 days.
- Outcomes included 4 deaths, 8 patients discharged on PEG feeding, and 12 with PEG removal after resuming normal feeding.
- Three severe complications occurred: 1 fatal aspiration and 2 cases of intra-abdominal leakage, both resolved.
Conclusions:
- PEG placement is a justified method for providing early enteral nutrition in severely injured patients with significant brain damage.
- Despite potential complications, PEG offers advantages over nasogastric tubes for long-term nutritional support in this patient population.
Abstract:
Early enteral nutrition improves the outcome of severely injured patients. To provide enteral nutrition, various methods are available. In a restrospective study we analysed the outcome of 24 severely traumatized patients (mean ISS = 44), in whom a percutaneous endoscopic gastrostomy (PEG) was used for enteral nutrition. All patients had been admitted to the intensive care unit with major cerebral injury. The mean duration of intensive care treatment and the in hospital stay were 28 and 71 days, respectively. PEG was introduced 14 days after hospital admittance. Enteral nutrition through the PEG was administered for 45 days. Four patients died, 8 patients were discharged from the hospital while being fed via the PEG and 12 patients resumed normal feeding and the PEG was removed. Three severe complications occurred; 1 patient aspirated massively and died; in 2 patients intra-abdominal leakage of the enteral nutrition occurred. Both patients recovered from this complication. We conclude that because of the advantages of early enteral nutrition on the one hand and the drawbacks of nasogastric feeding tubes on the other, in injured patients with severe cerebral damage, PEG placement is justified, despite the risk of complications.