Aim: Percutaneous endoscopic gastrostomy (PEG) is a procedure performed to provide long-term enteral nutritional support and is sometimes carried out while the patient is still in the intensive care unit (ICU). This study aimed to examine patients who underwent PEG in the ICU, to better understand the characteristics of this intervention and assess its appropriateness in the ICU.
Study Design: We conducted a retrospective review of 42 patients who underwent PEG during their stay in the medical ICU of a university hospital between January 1, 2018 and December 31, 2021. Data collected included demographic characteristics, underlying comorbidities, ICU admission details, PEG procedure specifics, and both ICU and post-discharge outcomes. Patients were grouped based on ICU survival and the presence of PEG-related complications, and statistical comparisons were made between these subgroups.
Results: The median patient age was 76.5 years, and 57% were male. Hypertension (59.5%) was the most common comorbidity, and the leading cause of ICU admission was acute respiratory failure (83.3%). The median ICU length of stay was 52 days, with PEG performed on a median of the 27th ICU day. Seventeen patients (40.5%) died in the ICU; however, none of these deaths were related to the PEG procedure. Minor complications occurred in 11 patients (26.2%). While there was no statistically significant difference in survival between those who developed complications and those who did not, both ICU and hospital stays were significantly longer in patients who developed complications. Among the 25 patients discharged or transferred from the ICU, 24 died within a median of four months. Only one patient was still alive as of June 2024, indicating a maximum survival of 52 months.
Conclusions: Given that 17 patients died before ICU discharge and 24 died within four months afterward, PEG placement should be carefully considered in the ICU setting and potentially deferred until after ICU discharge. The patient's long-term prognosis should be critically evaluated before proceeding with PEG placement.