PERCUTANEOUS ENDOSCOPIC GASTROSTOMY PLACEMENT IN TRAUMA PATIENTS: EARLY VS. DELAYED INITIATION OF ENTERAL FEEDING

Objectives: Currently, there is no fixed clinical standard for initiation of feeding after PEG tube placement. We aim to demonstrate that early enteral nutrition is as safe as delayed enteral nutrition in patients who have PEG tubes, which could lead to decreased malnutrition and faster recovery in critically ill patients.

Methods: We conducted a retrospective chart review of 263 patient records from the Prisma Health Trauma Registry, aged 15+, who received tube feeds via a PEG placement between January 1st, 2017 to March 31st 2022. Data were collected on timing after PEG insertion to initiate enteral feeds, feeding tolerance, complications, ICU and hospital lengths of stay, and mortality rates. Feeding intolerance was defined as high gastric residuals, nausea, emesis, sustained diarrhea, or bowel dilation/ileus. Patients were grouped by time delay in hours to initiate post-procedure feeds ( < 6, 6-12, 12-24 and > 24) and intolerance rates among the different groups were compared.

Results: Feeds were begun within 6 hours in 51% of patients (n=133), within 6 to 12 hours in 22% of patients (n=52), between 12 and 24 hours in 17% of patients (n=43) and after 24 hours in 10% of patients (n=29). After adjustment for demographic variables of age, sex and Injury Severity Score, the probability that a patient would experience feeding intolerance was 10% in those fed within 6 hours, 5.8% among patients fed between 6-12 hours, 4.7% among patients fed between 12-24 hours, and 10% among patients fed after 24 hours, for which no statistically significant difference was detected.

Conclusion: Our study adds to recent findings that starting EN for patients within 6 hours of PEG placement is not associated with an increase in feeding intolerance, nor aspiration events, when compared to patients whose EN is delayed. Even though there was still a large amount of provider generated variation in the timing of initiation of feeds after PEG, most of the patients in our study had EN started within 6 hours. These findings support standardizing the early initiation of EN after PEG placement in trauma patients.