Percutaneous Ultrasound-guided Placement of Gastrostomy Tube in Neurocritically Ill Patient
Oluwagbemiga Larinde1, Ayham Alkhachroum3, Nina Massad4, Kristine O'Phelan4, Amedeo Merenda5, Mohan Kottapally6, Douglas Houghton2, Yaroslav Bury2, Gerasim Sergey2
1Neurology, University of Miami/Jackson Memorial, 2University of Miami/Jackson Memorial, 3University of miami/Jackson, 4University of Miami, 5Univeristy of Miami Miller School of Medicine, 6University of Miami Miller School of Medicine
Objective:
To study feasibility of bedside PUG placement
Background:
Percutaneous ultrasound-guided gastrotomy (PUG) is a minimally invasive procedure done at the bedside. PUG is an alternative to the traditional PEG placement and believed to help reduce hospital length of stay (LOS) and cost. The experience of PUG placement in neurocritically ill patients performed by neuro-intensivists has not been reported.
Design/Methods:
In this retrospective single center study, we investigated neurocritically ill patients who underwent the PUG placement by neurointensivists. We collected data on basic demographics, procedure-related information (failed attempts and complications up to 90 days), and outcomes.
Results:
A total of 39 patients underwent PUG placement in 2023. Etiologies included stroke, traumatic brain injury, spinal cord injury, and status epilepticus. Median age of the patients was 56 (Q1 37, Q3 63), 77% were male, 28% Black, and 49% Hispanic. Median BMI was 26 (Q1 24, Q3 30), and 82% were on mechanical ventilation. On average, the procedure was performed 20 days post admission (Q1 14, Q3 26), with complications seen in 3 patients. One patient had minimal bleeding around the PUG site, that resolved without an intervention. Another patient had abdominal wall cellulitis. The third patient had diffuse pneumoperitonitis requiring antibiotics and a surgical intervention for a washout. The procedure failed in 2 patients (5%) due to guidewire malfunction and difficult anatomy, without any complications. Overall, 5 concomitant percutaneous tracheostomies were placed. Low doses of pressors were used in 4 patients due to sedation for the procedure. The median ICU LOS was 28 (Q1 21, Q3 35), and mRS of 5 (Q1 4.5, Q3 5) on discharge.
Conclusions:
We report the experience of PUG placement by neurointensivists in neurocritically ill patients. Overall, the procedure was feasible with low rates of failed attempts and complications. Future multicenter studies with larger cohorts are needed to confirm our findings.