Wei Margaret, Ho Elliot, Hegde Pravachan
Department of Internal Medicine, University of California Los Angeles, Los Angeles, CA, USA.
Division of Advanced Interventional Thoracic Endoscopy/Interventional Pulmonology, University of California San Francisco - Fresno, Fresno, CA, USA.
J Thorac Dis. 2021 Aug;13(8):5277-5296. doi: 10.21037/jtd-19-3728.
Critically ill patients are at increased risk for malnutrition as they often have underlying acute and chronic illness, stress related catabolism, decreased appetite, trauma and ongoing inflammation. Malnutrition is recognized as a leading cause of adverse outcomes, higher mortality, and increased hospital costs. Percutaneous endoscopic gastrostomy (PEG) tubes provide a safe and effective route to provide supplemental enteral nutrition to these patients. PEG placement has essentially replaced surgical gastrostomy as the modality of choice for longer term feeding in patients. This is a highly prevalent procedure with 160,000 to 200,000 PEG procedures performed each year in the United States. The purpose of this review is to provide an overview of current knowledge and practice standards with regards to placement of PEG tube in the Intensive Care Unit (ICU). When a patient is considered for a PEG tube, it is important to evaluate the treatment alternatives and identify the best option for each patient. In this review, we provide the advantages and disadvantages of various feeding modalities and devices. We review the indications and contraindications for PEG tube placement as well as the risks of this procedure. We then describe in detail the per-oral pull, per-oral push, and direct percutaneous techniques for PEG tube placement. Additionally, we review the feasibility of having interventional pulmonologists place PEG tubes in the ICU.
重症患者发生营养不良的风险增加，因为他们常常伴有潜在的急慢性疾病、应激相关的分解代谢、食欲下降、创伤以及持续的炎症反应。营养不良被认为是不良结局、更高死亡率以及医院成本增加的主要原因。经皮内镜下胃造口术（PEG）管为这些患者提供补充肠内营养提供了一条安全有效的途径。PEG置管已基本取代外科胃造口术，成为患者长期喂养的首选方式。这是一种非常普遍的操作，在美国每年进行16万至20万例PEG手术。本综述的目的是概述重症监护病房（ICU）中PEG管置入的当前知识和实践标准。当考虑为患者置入PEG管时，评估治疗方案并为每位患者确定最佳选择非常重要。在本综述中，我们介绍了各种喂养方式和装置的优缺点。我们回顾了PEG管置入的适应证和禁忌证以及该操作的风险。然后我们详细描述PEG管置入的经口牵拉、经口推送和直接经皮技术。此外，我们还综述了介入肺科医生在ICU置入PEG管的可行性。
