Percutaneous endoscopic gastrostomy (PEG) tubes are commonly placed in critically ill patients in the intensive care unit. This procedure is performed by a variety of specialists, such as gastroenterologists, surgeons and radiologists. Many of these patients may also require tracheostomy, which in our medical intensive care units is performed by interventional pulmonologists. We evaluated the feasibility of performing PEG placement in the same setting by interventional pulmonologists.
Tracheostomy was performed first under deep sedation or paralysis in the standard fashion. Once the airway was secure, PEG was performed with a standard kit (Ponsky Delux “Pull” PEG Kit, Bard Endoscopic Technologies, Billerica, MA) and endoscopic guidance with a video gastroscope (GIF-160, Olympus America, Melville, NY). Periprocedural antibiotics were given. All procedures were proctored by a thoracic surgeon. Patients with prior abdominal surgery were excluded.
Between 2/2003 and 3/2004, 24 PEGs have been placed. There were 13 females and 11 males. Patient ages ranged from 21-96 (mean 66). After a follow-up ranging from 1 –14 months, there were no associated long-term complications of the procedure and one of the tubes has subsequently been removed.
Bedside EGD with PEG in critically ill patients can be safely performed by the specially trained Interventional Pulmonologist, reflecting the widespread use of the procedure through many specialties.
As performing percutaneous tracheostomy (PDT) can decrease the wait for the intervention, and possibly, hospital stay, we expect the performance of PEG and PDT in the same setting to have an additive effect.
D.J. Feller-Kopman, None.