Pneumonia and mortality after percutaneous endoscopic gastrostomy insertion

Abstract

Amaç: Perkütan endoskopik gastrostomi nörolojik disfajisi olan hastalarda enteral beslenme imkan› sunmaktad›r. Otuz günlük mortalite oranlar› %4-26 aras›nda de¤iflmektedir ve perkütan endoskopik gastrostomi yerlefltirilmesinden sonra pnömoni s›kt›r. Gereç ve Yöntem: Bu çal›flma Malta'da gerçeklefltirilen (Ocak 2008-Haziran 2010

Decision Making for Enteral Nutrition in Adult Patients with Dysphagia – A Guide for Health Care Professionals

“…Blomberg et al, (2011) noted the link between low albumin levels pre-insertion of PEG and a high mortality rate post insertion. This link confirms that hypo-albuminaemia is a risk factor that should be considered in all patients being medically worked up for PEG placement [45,56,59,77,84]. Co morbidities like diabetes and cardiac disease were also noted to be significant risk factors for high mortality in patients post PEG placement [19,56,59,70,82].…”

“…Others [14] consider the prognosis and argue that a patient at the end stages of a disease should not be considered for PEG but should rather receive nutrition via NGT. No difference between NGT and PEG cohorts was found in the rate of complications [46], the rate of mortality post placement [45][46] or the occurrence of pneumonia post placement [46].…”

“…Strong evidence links poor nutrition upon hospitalization with poor medical outcomes, such as greater incidence of morbidity and mortality [45,73,80]. Malnourishment is measured using the body mass index (BMI), with a BMI of <18.5 indicating malnutrition (WHO, 1995).…”

“…Considering the multitude of risk factors that exist for poor outcomes post PEG insertion, it follows that a patient should be individually assessed for the presence of any risk factors before being recommended for the procedure [85][86][87]. A comprehensive assessment by the team needs to consider factors such as: 1) the potential benefits to the individual should they receive a PEG, 2) biochemical parameters, like blood albumin level, 3) multiple comorbidities, 4) prognosis, 5) and the presence of risk factors that may place a patient at risk of mortality post procedure, such as being over the age of 60 years and a low BMI [10,19,23,25,45,56,69,[87][88][89]90].…”

Semi-solid feeds may reduce the risk of aspiration pneumonia and shorten postoperative length of stay after percutaneous endoscopic gastrostomy (PEG)

“…Although peristomal site infection is often noted as the most common adverse event (AE) after PEG tube placement, it is seldom life-threatening and considered a minor AE 4. Feeding-related AEs have been identified as the main cause of death after PEG, with up to 50 % of postoperative early mortality (30 days) being attributed to aspiration pneumonia 5 6. This may be related to the persistence of gastroesophageal reflux (GER) of enteral feed after gastrostomy 7, even though PEG has been demonstrated to be superior to nasogastric tube feeding in terms of preventing GER 8 9.…”