Introduction: Many critically ill trauma and surgical patients require nutritional support. Patients needing long-term enteral access often undergo placement of surgical feeding tubes, including percutaneous endoscopic gastrostomy tube, laparoscopic gastrostomy tube, and open gastrostomy tube. This study was performed to determine national practice patterns for feeding after feeding tube placement.
Methods: A 16-question online survey was administered to members of the Eastern Association for the Surgery of Trauma via Qualtrics about feeding practices after placement of the feeding tube. Questions included demographics, training, current practice, annual procedural volume, timing to resume feeds: <2, 6, 12, or 24 h, methods to advance feeds, and reasons behind management decisions. For comparison, responses were grouped into "early" (≤6 h) and "late" (18-24 h) groups. The chi-square test was used, and P < 0.05 was significant.
Results: Five hundred sixteen Eastern Association for the Surgery of Trauma members completed the survey. Most (95%) respondents worked at a level 1 or 2 trauma center, and 68% are in academic practice. The most common feeding tube placement was percutaneous endoscopic gastrostomy (median = 25/y, interquartile range = 15-40). Responses showed variability in timing of when feeds were resumed after procedure. Early feeding was not affected by age (≤42 y), trauma center designation, volume, or training programs at the respondent's hospital. Graduates of surgical critical care fellowship were less likely to feed early (P = 0.043).
Conclusions: There is wide variability in feeding practices after surgical feeding tube placement. Given the large quantity of procedures performed, a randomized controlled trial should be performed to determine the optimal timing to resume feeds in critically ill patients.
Keywords: PEG; Percutaneous endoscopic gastrostomy; Practice pattern; Surgical feeding tubes.
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