Outcomes of Tracheostomy With Concomitant and Delayed Percutaneous Endoscopic Gastrostomy in the Neuroscience Critical Care Unit

Christa O'Hana S Nobleza; Vinciya Pandian; Ravirasmi Jasti; David H Wu; Marek A Mirski; Romergryko G Geocadin

doi:10.1177/0885066617718492

Outcomes of Tracheostomy With Concomitant and Delayed Percutaneous Endoscopic Gastrostomy in the Neuroscience Critical Care Unit

J Intensive Care Med. 2019 Oct;34(10):835-843. doi: 10.1177/0885066617718492. Epub 2017 Jul 4.

Authors

Christa O'Hana S Nobleza¹, Vinciya Pandian^{2

3}, Ravirasmi Jasti⁴, David H Wu⁵, Marek A Mirski^{4

5}, Romergryko G Geocadin^{4

5}

Affiliations

¹ 1 Department of Neurology, University of Mississippi Medical Center, Jackson, MS, USA.
² 2 Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD, USA.
³ 3 Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ 4 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ 5 Department of Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

PMID: 28675111
DOI: 10.1177/0885066617718492

Abstract

Background: In patients with severe neurologic conditions, percutaneous endoscopic gastrostomy (PEG) is typically performed either alone or with a tracheostomy. The characteristics and outcomes of patients receiving PEG concomitantly with a tracheostomy (CTPEG) and those receiving delayed PEG (DPEG) after a tracheostomy were compared.

Methods: Retrospective cohort study in a 24-bed neuroscience critical care unit (NCCU) at a tertiary care hospital. Consecutive patients admitted to the NCCU from April 2007 to July 2013 who underwent percutaneous tracheostomy and gastrostomy by the percutaneous tracheostomy team were included and grouped according to the timing of PEG placement: CTPEG versus DPEG.

Results: Of the 290 patients, 234 (81%) received CTPEG. Demographic and clinical characteristics were similar among the 2 groups except for a lower median (interquartile range [IQR]) body mass index (BMI; 27 [22.67-31.60] versus 30.8 [24.55-40.06], P = .017) and lower rate of acute respiratory distress syndrome (3.85% vs 10.71%, P = .048) in the CTPEG cohort. Furthermore, 59% of CTPEG cohort were neurology patients while 63% of DPEG were neurosurgery patients, P = .004. Primary outcomes showed shorter mean NCCU length of stay (LOS; 25 [12] vs 33 [17] days, P < .001) and median hospital LOS (32 [25-43] vs 37 [31-56] days, P = .002) for the CTPEG cohort. Secondary outcomes showed higher predischarge prealbumin levels (15.6 [7.75] vs 11.58 [5.41], P = .021) and lower median overall hospital cost (US$123 860.20 [US$99 024-US$168 713.40] vs US$159 633.50 [US$121 312-US$240 213.10], P = .0003) in the CTPEG group. Anatomic contraindications were the most common reason for DPEG (30%).

Conclusions: Among institutions with a tracheostomy team, the practice of tracheostomy with concomitant PEG placement may be considered as feasible as delayed PEG in carefully selected neurocritically ill patients with possible advantages of overall shorter NCCU and hospital LOS, higher predischarge prealbumin, and lower hospital costs. These findings may aid in decisions regarding the timing of PEG placement in the NCCU. Further prospective studies are warranted.

Keywords: critically ill; gastrostomy; neurocritical care; patient outcomes; tracheostomy.

MeSH terms

Adult
Aged
Critical Care*
Female
Gastrostomy / statistics & numerical data*
Hospital Mortality
Humans
Intensive Care Units*
Male
Middle Aged
Nervous System Diseases / mortality
Nervous System Diseases / physiopathology
Nervous System Diseases / therapy*
Retrospective Studies
Tracheostomy / statistics & numerical data*
Treatment Outcome