Risk Factors for Pneumonia After Percutaneous Endoscopic Gastrostomy

Patel, P. H.; Thomas, Eapen

doi:10.1097/00004836-199008000-00006

Cited by 44 publications

(26 citation statements)

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“…The 30-day mortality was 21%; 33% died 60 days after tube insertion and 60% later. Although PEG is indicated for gastric decompression in gastrointestinal obstruction due to cancer, especially cancer of the female reproductive system [12,13], it does not prevent aspiration or aspiration pneumonia [14][15][16]. Indeed a history of aspiration is a grave prognostic factor for PEG insertion with a high mortality [17].…”

Section: Indicationsmentioning

confidence: 99%

Indications for Percutaneous Endoscopic Gastrostomy Insertion: Ethical Aspects

Niv

Abuksis²

2002

Dig Dis

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Percutaneous endoscopic gastrostomy (PEG) is a popular technique for long-term enteral nutrition. However it is not beneficial in all cases, and may even prolong the process of dying. The present article discusses the main indications for PEG insertion, and the ethical considerations involved. Three main questions need to be answered: (1) for what purposes should PEG be used; (2) for what type of patients, and (3) when should PEG be inserted in the natural history of the patient’s illness? PEG is used in patients unable to maintain sufficient oral intake. It has been found to improve quality of life and/or to increase survival in patients with head and neck cancer, acute stroke, neurogenic and muscle dystrophy syndrome, growth failure (children) and gastric decompression. It led to no improvement in nutritional or functional status in patients with cachexia, anorexia, aspiration (and aspiration pneumonia), and cancer with a short life expectancy. Several court decisions have stipulated that PEG need be offered in patients in a persistent vegetative state or patients with senile dementia who have lost the ability for self-determination. Since the 30-day mortality after PEG insertion is very high for patients hospitalized in a general medical center, a ‘cooling off’ period of 30–60 days should be scheduled from the time of the PEG request to actual insertion.

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Section: Indicationsmentioning

confidence: 99%

Indications for Percutaneous Endoscopic Gastrostomy Insertion: Ethical Aspects

Niv

Abuksis²

2002

Dig Dis

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“…46 The major risk factors for post-PEG pneumonia include a pre-PEG history of aspiration pneumonia, presence of reflux esophagitis during endoscopy, and concurrent infection. 51,[52][53][54][55][56] Although not studied in ALS, a prokinetic agent (such as cisapride) to enhance gastric emptying may reduce the incidence of post-PEG aspiration. 57 There is some evidence that recurrent aspiration pneumonia in aphonic patients with ALS may be treated with conservative laryngectomy or laryngeal diveresion.…”

Section: What Is the Best Way To Detect Dysphagia In Als?mentioning

confidence: 99%

Practice parameter: The care of the patient with amyotrophic lateral sclerosis (an evidence-based review) [RETIRED]

et al. 1999

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(AAN) is charged with developing practice parameters for physicians. This evidence-based review addresses some of the major management issues in patients with ALS, and highlights the many areas in which more research is needed.Justification. ALS is a progressive, degenerative motor neuron disease of unknown cause. Muscle atrophy and spasticity in limb and bulbar muscles result in weakness and loss of ambulation, oropharyngeal dysfunction, weight loss, and ultimately respiratory failure. Although advances in understanding the pathophysiology of ALS have stimulated the development of new drug therapies, 1 the mainstay of treatment for ALS patients remains symptomatic management.The practice parameters presented here comprise the first recommendations for the management of ALS based on a prescribed review and analysis of the peer-reviewed literature. These practice parameters were developed to improve the care and the quality of life of people with ALS by providing a rational basis for managing the disease.Description of the process. A multidisciplinary task force, all with extensive ALS experience, included 19 physicians, 3 patients with ALS, 1 gastroenterologist, 1 pulmonologist, 1 occupational therapist whose mother has ALS, and 1 nurse. In addition, consultants with expertise on ethics, practice parameter development, and medical library research participated in the process. The task force agreed to investigate five areas: 1) informing the patient and the family about the diagnosis and prognosis (also called "breaking the news") of ALS; 2) symptomatic treatment; 3) nutrition, and decisions about percutaneous endoscopic gastroscopy (PEG); 4) respiratory insufficiency and mechanical ventilation; and 5) advance directives and palliative care. To help achieve this goal, they developed several guiding principles or attributes of care: Principles of ALS management1. High priority should be placed on patient self-determination or autonomy as an underlying assumption in the therapeutic relationship. Delivery of both information and care must take into consideration the cultural and psychosocial context of the patient and the family. 2. Patients and families need information that is timed appropriately for decision making, and delivered well in advance of major management crossroads, especially for respiratory care. Moreover, decision making is a dynamic process that may be subject to change as the disease becomes more severe.The investigators and institutions of the ALS Practice Parameters Task Force are listed in the Appendix on page 1320.

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“…Sonde de gastrostomie mise en place par endoscopie percutanée [30]. Mise en place si possible tant que la capacité vitale est supérieure à 50% de la valeur prédite.…”

Section: Dysphagieunclassified