Outcomes of Tracheostomy With Concomitant and Delayed Percutaneous Endoscopic Gastrostomy in the Neuroscience Critical Care Unit

Nobleza, Christa O’Hana S.; Pandian, Vinciya; Jasti, Ravirasmi; Wu, David H; Mirski, Marek A.; Geocadin, Romergryko G.

doi:10.1177/0885066617718492

Cited by 14 publications

(21 citation statements)

References 31 publications

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“…In addition, there are pre-COVID-19 data that suggest performing tracheostomy and gastrostomy procedures using a gastroscope and/or bronchoscope in the same sitting by a single specialty has a good safety profile with possible advantages of shorter ICU and hospital length of stay. [82][83][84][85] This could be considered in institutions with such expertise, but there might be concerns for the additional time required to perform percutaneous endoscopic gastrostomy placement, leading to extended exposure time.…”

Section: Role Of Preprocedural Covid-19 Testingmentioning

confidence: 99%

Use of Tracheostomy During the COVID-19 Pandemic

Lamb

Desai

Angel

et al. 2020

Chest

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BACKGROUND: The role of tracheostomy during the coronavirus disease 2019 (COVID-19) pandemic remains unknown. The goal of this consensus statement is to examine the current evidence for performing tracheostomy in patients with respiratory failure from COVID-19 and offer guidance to physicians on the preparation, timing, and technique while minimizing the risk of infection to health care workers (HCWs). METHODS: A panel including intensivists and interventional pulmonologists from three professional societies representing 13 institutions with experience in managing patients with COVID-19 across a spectrum of health-care environments developed key clinical questions addressing specific topics on tracheostomy in COVID-19. A systematic review of the literature and an established modified Delphi consensus methodology were applied to provide a reliable evidence-based consensus statement and expert panel report. RESULTS: Eight key questions, corresponding to 14 decision points, were rated by the panel. The results were aggregated, resulting in eight main recommendations and five additional remarks intended to guide health-care providers in the decision-making process pertinent to tracheostomy in patients with COVID-19-related respiratory failure. CONCLUSION: This panel suggests performing tracheostomy in patients expected to require prolonged mechanical ventilation. A specific timing of tracheostomy cannot be recommended. There is no evidence for routine repeat reverse transcription polymerase chain reaction testing in patients with confirmed COVID-19 evaluated for tracheostomy. To reduce the risk of infection in HCWs, we recommend performing the procedure using techniques that minimize aerosolization while wearing enhanced personal protective equipment. The recommendations presented in this statement may change as more experience is gained during this pandemic.

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Section: Role Of Preprocedural Covid-19 Testingmentioning

confidence: 99%

Use of Tracheostomy During the COVID-19 Pandemic

Lamb

Desai

Angel

et al. 2020

Chest

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“…Delays in proceduralist availability are associated with increased ICU length of stay and overall hospital costs. 24 Limitations of this study include differences in clinical operations and underlying disease processes, given that the COVID-19 pandemic began shortly after identification of the PRG cohort and before PUG recruitment. No patients in the PRG cohort had COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Ultrasound Guided Gastrostomy Tube Placement: A Prospective Cohort Trial

Reis

Brejt

Weintraub

et al. 2021

J Intensive Care Med

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Background: To compare the safety and efficacy of percutaneous ultrasound guided gastrostomy (PUG) tube placement with traditional fluoroscopic guided percutaneous gastrostomy tube placement (PRG). Methods: A prospective, observational, non-randomized cohort trial was performed comparing 25 consecutive patients who underwent PUG placement between April 2020 and August 2020 with 25 consecutive patients who underwent PRG placement between February 2020 and March 2020. Procedure time, sedation, analgesia requirements, and complications were compared between the two groups in non-inferiority analysis. Results: Technical success rates were 96% in both groups (24/25) of procedures. Ninety-two percent of patients in the PUG cohort were admitted to the ICU at the time of G-tube request. Aside from significantly more COVID-19 patients in the PUG group ( P < .001), there was no other statistically significant difference in patient demographics. Intra-procedure pain medication requirements were the same for both groups, 50 micrograms of IV fentanyl ( P = 1.0). Intra-procedure sedation with IV midazolam was insignificantly higher in the PUG group 1.12 mg vs 0.8 mg ( P = .355). Procedure time trended toward statistical significance ( P = .076), with PRG being shorter than PUG (30.5 ± 14.1 minutes vs 39.7 ± 17.9 minutes). There were 2 non-device related major complications in the PUG group and 1 major and 1 minor complication in the PRG group. Conclusion: PUG is similar in terms of complications to PRG gastrostomy tube placement and a safe method for gastrostomy tube placement in the critically ill with the added benefits of bedside placement, elimination of radiation exposure, and expanded and improved access to care.

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“…Prior studies have noted that the prognosis and LOS of patients with tracheostomy may relate to complex co-morbidities, 113e116 requirement for emergent airway, and patient characteristics. 56,57,117 Likelihood of prolonged LOS was increased two-to threefold in neonates compared with children 1e3 yr old. There was a stepwise increase in LOS as a function of increasing comorbidities, with a two-to three-fold LOS increase with four or more co-morbidities.…”

Section: Duration Of Carementioning

confidence: 97%