To PEG or not to PEG: Trends in Gastrostomy Tube Needs in Patients Requiring Tracheostomy

Introduction

Tracheostomy is a commonly performed procedure and often combined with percutaneous endoscopic gastrostomy tube (PEG) placement, a type of gastrostomy tube (GT) utilized to provide durable feeding access. Many patients pass swallow evaluations (SE) prior to discharge, raising the question of optimal timing of GT placement. The purpose of this study was to assess how frequently a GT is required at time of discharge in patients needing a tracheostomy for failure to wean off invasive mechanical ventilation (MV).

Methods

This was a retrospective, IRB exempt analysis of all patients that received tracheostomy and GT at a Level II trauma center over an 18-mo period. Medical records were reviewed for key patient demographics and clinical course.

Results

159 patients included, median hospital length of stay of 33 d, average time to tracheostomy 17 d, and 17-d median time to oral diet after tracheostomy. PEG was placed at time of tracheostomy in 35% of patients, with 52.8% receiving a GT in the acute care setting. Overall, only 15 patients (9.4%) had continued requirement for a GT at the time of discharge. The remaining 144 patients either died/discharged to hospice (n = 36, 22.6%) or demonstrated the ability to eat prior to discharge from acute care setting (n = 108, 67.9%).

Conclusions

In patients requiring tracheostomy for failure to wean off invasive MV, only 9.4% actually needed GT placement. Depending on institutional and regional capabilities, this study suggests that waiting to place a GT may be a reasonable approach in patients who need tracheostomy for failure to wean off invasive mechanical ventilation.