Pilot Quality Improvement Study: Exploring PEG Placements in Critically Ill COVID-19 Patients
Nutrition, Food Science and Packaging
Journal of Parenteral and Enteral Nutrition
Purpose: Since the start of the COVID-19 pandemic, health care knowledge related to COVID-19 patient care has continually evolved. Clinicians are trying to balance optimizing care and minimizing the risk of staff contracting COVID-19. Critically ill COVID-19 patients admitted to the intensive care units (ICUs) at our facility that are intubated will start receiving enteral nutrition support within one to two days. Those who require intubation for about two weeks or greater will often get a tracheostomy tube placed. Under normal circumstances, our ICU team often places a percutaneous endoscopic gastrostomy (PEG) tube for critically ill patients who are expected to need nutrition support for more than 4 weeks. The above-mentioned procedures are all aerosolizing processes that increase the risk of staff getting COVID-19. During this pandemic, our ICU teams have been hesitant to routinely place PEG tubes to limit staff exposure. The purpose of this quality improvement study was to characterize the baseline and health outcomes of critically ill COVID-19 patients with and without PEG placements.
Methods: Inclusion criteria included critically ill COVID-19 patients, age 18 or older, admitted to our ICUs starting March 10, 2020, and required nutrition support. Data was gathered retrospectively from electronic medical charts, and data collection is ongoing.
Results: A total of 22 patients (average age 57.2 ± 16.6 years, 27.6% female, 50% Hispanic, average BMI at admission = 33.2 ± 7.2 kg/m2) were included in our study. Sixteen of the patients did not receive PEG tubes prior to discharge while six patients had PEG tubes while in the ICU. In general, the patients that received PEG placements appeared to be more critically ill as evidenced by admission data (higher BMI of 36.4 ± 9.9 kg/m2 versus BMI of 32.0 ± 5.8 kg/m2 in the no PEG group, 66.7% with hypertension versus 56.3% in the no PEG group, and 66.7% with diabetes mellitus versus 37.5% in the no PEG group), 100% receiving tracheostomies (versus 50% in the no PEG group), having a longer length of stay of 47.3 ± 4.7 days (versus 36.8 ± 12.6 days in the no PEG group), and a higher incidence of death at 50% (versus 37.5% in the no PEG group). On average PEG placement occurred on length-of-stay day number 33.0 ± 19.2.
Conclusion: Our preliminary data support routine PEG placements in COVID-19 patients inline with ASPEN practice guidelines. Our COVID-19 Task Force team is now placing PEG tubes towards the end of ICU stays, after a negative COVID-19-test has been confirmed, which ensures staff safety. As this study is ongoing, we hope to report further findings that can inform PEG placement practices in critically ill COVID-19 patients.
Brittney Patterson, Janine Berta, and Kasuen Mauldin. "Pilot Quality Improvement Study: Exploring PEG Placements in Critically Ill COVID-19 Patients" Journal of Parenteral and Enteral Nutrition (2021). https://doi.org/10.1002/jpen.2095