B. E. Love1, K. Inaba1, K. Matsushima1, D. Clark1, M. Lewis1, D. Demetriades1, A. Strumwasser1 1LAC+USC Medical Center,Acute Care Surgery,Los Angeles, CA, USA
Introduction: Bedside percutaneous gastrostomy (PEG) tube placement in patients with traumatic brain injury (TBI) is central to providing enteral access in the intensive care unit. It obviates the need for a trip to the operating theater or interventional radiology suite and can expedite ICU discharge in patients awaiting rehabilitation beds. However, optimal placement may require image guidance to ensure appropriate placement. We compared outcomes between the different techniques used for gastrostomy tube placement in these patients.
Methods: A retrospective chart review of all patients admitted for TBI at our Academic Level I Trauma Center was performed (2009-2017). All adult patients with TBI that underwent gastrostomy placement were eligible for analysis. Outcomes included hospital length-of-stay (HLOS), ICU LOS, ventilator days, and complications related to PEG placement.
Results: A total of 206 patients with TBI and gastrostomy tubes were admitted during the study period. Average ISS was 22 and ICU LOS was 32 days; 119 (58%) patients underwent bedside gastrostomy (PEG); 70 (34%) underwent image-guided gastrostomy (IGG); 17 (8%) underwent open gastrostomy (OG). Complications related to the gastrostomy occurred in 10 (5%) of all the tubes placed; 7 (70%) occurred in the PEG group, 2 (20%) in the IGG group, and 1 (10%) occurred in the OG group.
Conclusion:In patients with severe traumatic brain injury that require gastrostomy tube placement, tubes placed by surgeons in the operating room remains the most durable option for gastrostomy placement. However, image-guided tubes provide a reliable alternative when surgically-placed feeding access is not an option.