P. T. Evans1, M. C. Smith2, S. J. Schneeberger1, K. M. Prendergast1, A. B. Peetz2, E. B. Kopp2, N. E. Collins2, O. D. Guillamondegui2, B. M. Dennis2 1Vanderbilt University,School Of Medicine,Nashville, TN, USA 2Vanderbilt University Medical Center,Division Of Trauma And Surgical Critical Care,Nashville, TN, USA
Introduction: Patients with persistent respiratory failure and/or neurologic deficits often require tracheostomy and/or gastrostomy prior to ICU liberation. At our institution, a specialized multidisciplinary consult service was created to facilitate the placement of these devices. We describe the outcomes of a multidisciplinary bedside procedure service in our institution.
Methods: A multidisciplinary service consisting of a trauma surgeon, nurse practitioner, and critical care nurse was created to efficiently evaluate and place tracheostomies and gastrostomy tubes in the inpatient setting. The service manages the device post-procedure until removal. Patients for whom bedside percutaneous tracheostomy or percutaneous endoscopic gastrostomy (PEG) were performed by our institution’s tracheostomy and PEG service were identified from an institutional database for bedside procedures (August 2013-January 2018). Demographic data, data on complications, as well as time from consult request to procedure were recorded. Descriptive statistics were calculated.
Results: 1,075 tracheostomies and 592 PEGs were identified. Median age was 53.1 for tracheostomy and 59.8 for PEG. Median BMI were 28.1 and 25.7 respectively. 99% of tracheostomies and 77% of PEGs were performed in ICUs. There were no periprocedural airway losses. 2% of patients who underwent tracheostomy had complications requiring an additional procedure. 96% of PEGs were performed successfully at bedside. 23 patients (4%) required an additional procedure after attempted PEG, 14 of which were for procedures aborted at bedside. 75.5% of tracheostomies and 61% of PEGs were performed within 1 day of consult.
Conclusion: A multidisciplinary consult service is a safe and efficient model for performing bedside percutaneous tracheostomies and PEGs in the ICU. With the increasing need for efficiency in our current healthcare economic climate, such a model can help streamline care of the ICU patient and facilitate liberation.