High rate of percutaneous gastrostomy placement in COVID-19 patients with low overall complications.
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ABSTRACT:
SUBMITTER: Lipcsey M
PROVIDER: S-EPMC8262403 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The aim of the study was to report the use of nasogastric tube bridles to avoid dislodging of percutaneous endoscopic gastrostomy tubes. Specifically it was intended to see if they reduced feeding time, medical input and costs.and setting This was a cohort study in a district hospital setting.164 patients admitted with conditions causing acutely impaired swallowing.140 of 164 patients referred received a NGT bridle.Of these, 49 (35%) died by 28 days and 68 (48.6%) at 1 year; 73 (52.1%) had regained adequate oral intake at 28 days and 27 (19.2%) had proceeded to PEG. Of those not bridled, nine (37.5%) died by 28 days and 10 (41.7%) at 1 year with the remainder eating. There was no significant difference in mortality between groups. There were no complications attributed to bridles.We conclude that nasogastric bridles are safe and represent an appropriate method to maintain nutrition while seeing if the underlying disease process will stabilise in these critically ill patients. They have the benefits of avoiding unnecessary PEG and the associated complications and cost.
| S-EPMC5517266 | biostudies-other
Project description:To report the results of early enteral feeding in patients with cancer after outpatient placement of a percutaneous fluoroscopy-guided gastrostomy (PFG).From January 2008 through December 2008, 121 consecutive patients with cancer underwent outpatient placement of a PFG for nutrition. Of these patients, 118 patients met criteria for early feeding, and 113 were successfully fed early (after at least 3 hours). Of the patients fed early, 5 had insufficient follow-up for further analysis leaving 108 patients for outcomes analysis. After placement of the PFG, patients were put on low-wall suction via the PFG for 1 hour followed by feeding via the PFG at least 3 hours after placement. Follow-up evaluation was done the next business day. The medical records were reviewed for 30-day outcomes of early feeding, technical aspects of the procedures, and complications.After placement of the PFG, 98% (118 of 121) of patients met criteria for early feeding, and 93% (113 of 121) of patients were successfully fed early. The median time between the end of the procedure and initiation of feeding was 4 hours (interquartile range, 3.7-4.4 h). The 30-day minor complication rate was 14% (15 of 108), and the 30-day major complication rate was 1% (1 of 108). No complications were directly attributable to early feeding.Early initiation of tube feedings after outpatient placement of a PFG was well tolerated in patients with cancer and carried comparable risks to previously reported results using traditional delayed feeding protocols. Early feeding provided patients with prompt enteral nutrition and eliminated the need for routine hospital admission after the procedure.
| S-EPMC4325364 | biostudies-literature
Project description:Background and study aims ?Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) are techniques used for long-term enteral feeding. Our primary aim was to analyze procedure-related and 30-day mortality and complications between PEG and PRG in relation to indications. Patients and methods ?A single-center retrospective analysis was performed thath included all adult patients receiving initial PEG (January 2008 until April 2016) and PRG (January 2010 until April 2016). Outcomes were mortality (procedure-related, 30-day), complications (early (??30 days) and late) and success rates. Results ?A total of 760 procedures (469 PRG and 291 PEG) were analyzed. Most common indications were head and neck cancer (HNC), cerebrovascular accident (CVA) and amyotrophic lateral sclerosis (ALS). Success rates for placement were 91.2?% for PEG and 97.1?% for PRG ( P ?=?0.001). Procedure-related mortality was 1.7?% in PEG and 0.4?% in PRG ( P ?=?0.113). The 30-day mortality was 10.7?% in PEG and 5.1?% in PRG ( P ?=?0.481 after multivariate logistic regression) CVA was associated with higher 30-day mortality, whereas ALS, higher body weight, and prophylactic placements in HNC were associated with lower rates. Tube-related complications were less frequent in PEG, both early (2.7?% vs. 26.4?%, P ???0.001) and late (8.6?% vs. 31.5?%, P ???0.001). The percentage of major complications and infections did not differ. Conclusions ?With respect to procedure-related and 30-day mortality, PEG and PRG compare equally. PRG had a higher procedural success rate. Tube-related complications and pain are less frequent after PEG compared to PRG. The choice for either PEG or PRG therefore should primarily be based on local facilities and expertise.
| S-EPMC6811353 | biostudies-literature
Project description:To explore the relationship between SARS-CoV-2 infection in different time before operation and postoperative main complications (mortality, main pulmonary and cardiovascular complications) 30 days after operation; To determine the best timing of surgery after SARS-CoV-2 infection.
| 5792 | ecrin-mdr-crc
Project description:Respiratory failure in coronavirus disease 2019 (COVID-19) patients with prolonged endotracheal intubation may require a tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube placement to facilitate recovery. Both techniques are considered high-risk aerosol-generating procedures and present a heightened risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for operating room personnel. We designed, simulated, and implemented a portable, continuous negative pressure, operative field barrier system using standard equipment available in hospitals to enhance health care provider safety during high-risk aerosol-generating procedures.
| S-EPMC7771639 | biostudies-literature
Project description:Inadvertent injury to interposing organs during percutaneous endoscopic gastrostomy (PEG) tube placement is a feared complication of this common and generally safe procedure. Transhepatic PEG insertion is likely an underrepresented complication which may be identified incidentally on imaging or present with life-threatening conditions such as sepsis or massive bleeding. Use of ultrasound in patients with known hepatomegaly may possibly help avoid this complication. We hereby report a case of transhepatic PEG insertion, one of 16 only other cases published in the literature, and review the characteristics of the previous reported cases.
| S-EPMC7037529 | biostudies-literature
Project description:Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated disease COVID-19 (coronavirus disease 2019) has presented graduate medical education (GME) training programs with a unique set of challenges. One of the most pressing is how should hospital systems that rely on graduate medical residents provide appropriate care for patients while protecting trainees. This question is of particular concern as healthcare workers are at high risk of SARS-CoV-2 exposure. Objective: This cross-sectional study sought to assess the impact of hospital COVID-19 patient placement on pediatric graduate medical residents by comparing rates of SARS-CoV-2 seroconversion rates of residents who worked on designated COVID-19 teams and those who did not. Methods: Forty-four pediatric and medicine-pediatric residents at Riley Children's Hospital (Indianapolis, IN) were tested for SARS-CoV-2 immunoglobulin M (IgM) and IgG seroconversion in May 2020 using enzyme-linked immunosorbent assays (Abnova catalog no. KA5826), 2 months after the first known COVID-19 case in Indiana. These residents were divided into two groups: those residents who worked on designated COVID-19 teams, and those who did not. Groups were compared using χ2 or Fisher exact test for categorical variables, and continuous variables were compared using Student t testing. Results: Forty-four of 104 eligible residents participated in this study. Despite high rates of seroconversion, there was no difference in the risk of SARS-CoV-2 seroconversion between residents who worked on designated COVID-19 teams (26% or 8/31) and those who did not (31% or 4/13). Eleven of 44 residents (25%) tested positive for SARS-CoV-2 IgG, whereas only 5/44 (11.4%) tested positive for SARS-CoV-2 IgM, without a detectable difference between exposure groups. Conclusion: We did not observe a difference in SARS-CoV-2 seroconversion between different exposure groups. These data are consistent with growing evidence supporting the efficacy of personal protective equipment. Further population-based research on the role of children in transmitting the SARS-CoV-2 virus is needed to allow for a more evidence-based approach toward managing the COVID-19 pandemic.
| S-EPMC8116566 | biostudies-literature
Project description:ObjectiveWe sought to determine the association of gastrostomy placement on post-NICU-discharge resource utilization in premature infants.Study designWe performed a propensity-matched retrospective cohort study of NICU infants born under 32-week gestation in US Children's Hospitals. Multivariable logistic regression and propensity score-matching were used to determine the association of gastrostomy placement on 90-day hospital readmissions and emergency department visits adjusting for salient patient characteristics.ResultA total of 12,621 premature infants were included of which 697 (5.5%) underwent gastrostomy placement. After propensity matching, infants who underwent gastrostomy placement have a higher rate of 90-day inpatient readmission (41.9 vs 26.3%, p < 0.001) and emergency department visit (27.1 vs 16%, p < 0.001).ConclusionPremature infants who undergo gastrostomy placement have increased the risk of inpatient readmission and emergency department visits after NICU discharge. Gastrostomy placement likely is both a driver and marker for increased resource utilization in premature infants post-NICU discharge.
| S-EPMC7513590 | biostudies-literature
Project description:Coronavirus disease 2019 (COVID-19), an acute onset pneumonia caused by a novel Betacoronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has rapidly evolved into a pandemic. Though its origin has been linked to the Wuhan City of China's Hubei Province in December 2019, recent reports claim that the original animal-to-human transmission of the virus probably happened sometime between September and October 2019 in Guangdong Province, rather than Hubei. As of July 3, 2020, India has reported a case positivity rate of 6.5% and a fatality rate of 2.8%, which are among the lowest in the world. Also, the severity of the disease is much less among Indians as evidenced by the low rate of ICU admission (15.3%) and the need for mechanical ventilation (4.16%). As per the World Health Organization (WHO) situation report 165 on July 3, 2020, India has one of the lowest deaths per 100,000 population (1.32 deaths against a global average of 6.04). Several factors related to the pathogen, host and environment might have some role in reducing the susceptibility of Indians to COVID-19. These include some ongoing mutations that can alter the virulence of the circulating SARS-CoV-2 strains, host factors like innate immunity, genetic diversity in immune responses, epigenetic factors, genetic polymorphisms of ACE2 receptors, micro RNAs and universal BCG vaccination, and environmental factors like high temperature and humidity which may alter the viability and transmissibility of the strain. This perspective -highlights the potential factors that might be responsible for the observed low COVID-19 fatality rate in Indian population. It puts forward several hypotheses which can be a ground for future studies determining individual and population susceptibility to COVID-19 and thus, may offer a new dimension to our current understanding of the disease.
| S-EPMC7399343 | biostudies-literature
Project description:BackgroundA portable disposable ultrathin endoscope (DUE) with high visual quality and maneuverability would reduce the need for expensive facilities and emergency endoscopy could be available anywhere. It would increase patient satisfaction, prevent unnecessary sedation, and reduce infection. Our aim was to evaluate the usefulness of portable DUE in performing percutaneous endoscopic gastrostomy (PEG).MethodsWe prospectively enrolled patients who underwent PEG under DUE guidance and compared them with historical controls who underwent PEG under conventional ultrathin endoscopy (CUE) guidance. The primary outcomes were successful stomach visualization and PEG tube insertion.ResultsTwenty-five patients (19 male) were enrolled and compared with 25 gender and indication-matched controls. The most common indications for PEG were aspiration due to stroke or brain injury, dementia, and head and neck cancer. Entrance into the stomach was achieved in 92.0% (23/25) and 96% (24/25) in the DUE and CUE groups, and PEG was performed in 91.3% (21/23) and 95.8% (23/24), respectively. The mean insertion time for the DUE and CUE groups were 22.7 ± 9.3 minutes and 17.1 ± 5.7 minutes (P = 0.044). The 3 cases of failure to reach the stomach in both groups were caused by esophageal blockage. The 3 cases of failed PEG tube insertion were caused by poor visualization of the insertion site. Bleeding and pneumoperitoneum occurred in 1 and 2 patients in the DUE group. One case of fever was noted in the CUE group. All adverse events were conservatively managed.ConclusionsOur study shows that portable DUE in facilities without endoscopy equipment may be clinically feasible.
| S-EPMC5134776 | biostudies-literature