title: Outcome of direct percutaneous endoscopic jejunostomy tube placement for nutritional support in critically ill, mechanically ventilated patients.
abstract: OBJECTIVE
  Gastrointestinal function is adversely affected in critically ill mechanically ventilated patients. The most common abnormality is delayed gastric emptying. Among the options for postpyloric feeds, direct percutaneous endoscopic jejunostomy (PEJ) provides a permanent, reliable, and direct access to the small bowel and can be used for full enteral feedings, thus eliminating the need for parenteral nutrition.
  
  
  METHODS
  All patients who underwent direct PEJ tube placement while mechanically ventilated in the intensive care unit (ICU) were evaluated. For each patient the following factors were identified: age, indication for ICU admission and PEJ placement, nutritional support before and after PEJ placement, calories received, complications, and outcome.
  
  
  RESULTS
  Seventeen patients underwent the procedure. All had successful placement of direct PEJ tube. There was a single complication. Within 24 hours of PEJ placement, 16 of 17 patients tolerated jejunal feedings. All patients progressed to their established nutritional goals. There were no cases of aspiration of enteral feedings. In the 16 patients, total parenteral nutrition (TPN) was not required once PEJ tubes were placed. Thirteen patients were discharged home or to a rehabilitation facility with jejunal feedings.
  
  
  CONCLUSIONS
  Direct PEJ placement is a safe and reliable device that can be successfully placed in critically ill, mechanically ventilated patients. With this procedure, all patients can meet their nutritional requirements and eliminate the need for TPN.
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: R
authors.initials: R
authors.lastname: Barrera
authors.forename: M
authors.initials: M
authors.lastname: Schattner
authors.forename: S
authors.initials: S
authors.lastname: Nygard
authors.forename: M
authors.initials: M
authors.lastname: Ahdoot
authors.forename: A
authors.initials: A
authors.lastname: Ahdoot
authors.forename: S
authors.initials: S
authors.lastname: Adeyeye
authors.forename: J
authors.initials: J
authors.lastname: Groeger
authors.forename: M
authors.initials: M
authors.lastname: Shike
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000145:classification; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007582:Jejunostomy; D008297:Male; D008875:Middle Aged; D009519:New York City; D012121:Respiration, Artificial; D016896:Treatment Outcome