Retrospective analysis of the long-term outcomes of percutaneous endoscopic gastrostomy in critically ill patients and the satisfaction of their caregivers.

OBJECTIVE: Long-term benefits of percutaneous endoscopic gastrostomy and satisfaction of patients' caregivers have not been investigated in the literature in detail. Hence, this study was carried out to investigate the long-term nutritional benefits of percutaneous endoscopic gastrostomy in critically ill patients and their caregivers' acceptance and satisfaction rates. PATIENTS AND METHODS: The population of this retrospective study consisted of critically ill patients who underwent percutaneous endoscopic gastrostomy between 2004 and 2020. Data about the clinical outcomes were obtained via telephone interviews using a structured questionnaire. The long-term benefits of the procedure in terms of weight change and the current thoughts of the caregivers about percutaneous endoscopic gastrostomy were addressed. RESULTS: The study sample consisted of 797 patients with a mean age of 66.4 ± 17.1 years. Patients' Glasgow Coma Scale scores ranged from 4.0 to 15.0, with a median score of 8. Hypoxic encephalopathy (36.9%) and aspiration pneumonitis (24.6%) were the most common indications. There was neither change in body weight nor weight gain in 43.7% and 23.3% of the patients, respectively. Oral nutrition could be recovered in 16.8% of the patients. Of the caregivers, 37.8% stated that percutaneous endoscopic gastrostomy was beneficial. CONCLUSIONS: Percutaneous endoscopic gastrostomy may be a feasible and effective method for long-term enteral nutrition in critically ill patients treated in intensive care units.

Impact of positive end-expiratory pressure with alveolar recruitment maneuver on respiratory and oxygenation parameters of patients during laparoscopic bariatric surgery.

OBJECTIVE: Laparoscopic bariatric surgery is frequently associated with disturbances in respiratory mechanics. An alveolar recruitment maneuver (ARM) with positive end-expiratory pressure (PEEP) is a strategy to overcome such respiratory conditions. This study aimed to evaluate the effect of ARM+PEEP on intraoperative and postoperative respiratory and hemodynamic parameters of patients with laparoscopic bariatric surgery. PATIENTS AND METHODS: Patients who underwent laparoscopic bariatric surgery between 2009 and 2016 were retrospectively evaluated. The study sample was divided into four groups based on PEEP values and the presence of ARM: Group PEEP 5 (5 cm H2O PEEP only), Group PEEP 5/RM (5 cm H2O PEEP plus ARM), Group PEEP 10 (10 cm H2O PEEP only), Group PEEP 10/RM (10 cm H2O PEEP plus ARM). Patients' demographic characteristics, ventilatory, respiratory, and oxygenation parameters were recorded. Oxygenation index (PaO2/FiO2) was the study's primary outcome. RESULTS: There were 156, 158, 299, and 210 patients in Groups PEEP 5, PEEF 5/RM, PEEP 10, and PEEP 10/RM, respectively. Tidal volume, driving tidal volume/compliance, PaO2, PaO2/FiO2, and PaCO2 were significantly lower in Groups PEEP 5 and PEEP 5/RM, whereas SpO2 and FiO2 were significantly higher in Groups PEEP 5 and PEEP 5/RM (p<0.05). Patients in Group PEEP 5 had significantly higher end-tidal carbon dioxide (EtCO2) values than those of other groups (p<0.001). Patients in Group PEEP 5/RM had significantly higher SpO2 values than those in Group PEEP 5 (p<0.001). Rate of postoperative atelectasis was significantly higher in Group PEEP 5/RM compared to the other groups (p=0.011). CONCLUSIONS: A PEEP level of at least 10 cm H2O with ARM improved intraoperative respiratory parameters and caused a significant reduction in postoperative atelectasis.