4737 Outcome of direct percutaneous endoscopic jejunostomy tube placement for nutritional support in critically-ill, mechanically ventilated patients.

Abstract

Background: Gastrointestinal function is adversely affected in critically-ill, mechanically ventilated patients. The most common abnormality is delayed gastric emptying. This may lead to intolerance of gastric enteral feedings despite the presence of a functioning small bowel, and may predispose to aspiration pneumonia. Placement of a direct percutaneous endoscopic jejunostomy tube (PEJ) provides direct access to the small bowel and may therefore be the preferred route of access in critically-ill, mechanically ventilated patients who require enteral nutrition support. Methods:A review of the records of all patients who underwent direct PEJ tube placement while mechanically ventilated in the ICU was undertaken. For each patient the following factors were identified: age, indication for ICU admission and PEJ placement, nutritional support prior to and after PEJ placement, calories received, complications (aspiration, diarrhea, infection, bleeding, abdominal pain, leakage, or any procedural complications), and outcome. Results: 17 patients were studied. All had successful placement of direct PEJ tubes. The mean age was 64 years with a range of 25-83 years. Indications for PEJ placement included: aspiration pneumonia =9, intolerance of gastric enteral feedings =4, anastomotic leak after esophagectomy/gastric pull-up =3, duodenal obstruction =1. There was a single complication (colonic perforation). 15/17 patients tolerated jejunal feedings within 24 hours of PEJ placement. The mean daily caloric intake through the PEJ tube was 1994 cal (range 1440-2700) and all were able to progress to their established nutritional goals. There were no cases of aspiration of PEJ feeds. 13 patients required total parenteral nutrition (TPN) prior to PEJ placement. In all these patients TPN was not required once PEJ tubes were placed. 12 patients were discharged to home or a rehabilitation facility with jejunal feeds, 3 expired in the ICU, 1 was able to resume oral intake, and 1 remains hospitalized with continued enteral feedings. Conclusions: Direct PEJ is a safe and effective method to provide enteral nutrition support to critically-ill, mechanically ventilated patients who may not tolerate gastric enteral feeds and who might otherwise require TPN.