BEDSIDE PERCUTANEOUS ENDOSCOPIC GASTROSTOMY - A SAFE ALTERNATIVE FOR EARLY NUTRITIONAL SUPPORT IN CRITICALLY ILL TRAUMA PATIENTS

Background: Percutaneous endoscopic gastrostomy (PEG) is a good altern ative that provides long-term nutritional support and is associated wi th minimal morbidity. Methods: During a 24-month period, we studied 54 critically injured patients who underwent early PEG to provide entera l nutritional support. Patients were selected due to the inability to tolerate intake by mouth secondary to multiple associated injuries, es pecially to the central nervous system. Results: All patients sustaine d multiple injuries with an average Injury Severity Score of 27. The m ean Glasgow-Coma Scale at the time of admission was 7 and at the time of the PEG was 10. Eleven patients (20%) had an intracranial pressure (ICP) device, and there was no significant increase in the mean TCP be fore, during,or after the procedure. In 63% of patients, tube feedings were interrupted for a variety of problems in the 72 h preceding the PEG, and in 70% of patients an average of five radiographs were obtain ed to document tube position. In 95% of patients, the nutritional goal was achieved within 48 h of PEG placement. There were one immediate a nd two delayed complications after PEG placement. There were two death s, neither related to the PEG placement. Conclusions: Early PEG in cri tically injured patients is a safe and effective method of providing a ccess to the GI tract for nutritional support. In patients with signif icant brain injuries, adequate sedation and the presence of an ICP mon itor help to minimize secondary insults to the brain.