Interventional pulmonology (IP) represents a rapidly growing and developing subspecialty within pulmonary medicine. To the intensivist, given the elaborate undertakings with respect to airway, lung and pleural disease management-IP has shown an increasing presence and remain a major ally in the care of these patients. Thus, an understanding of the different roles that IP could offer to the intensivist is of prime importance in the multi-disciplinary care of the complex patients within the intensive care units, particularly in relation to lung, airway and pleural diseases. This review article will explore the different intersections of IP in critical care and discuss the applications of this discipline within the highly complex critical care environment.

• Hemoptysis
• Central airway obstruction
• Rigid bronchoscopy
• Critical care
• Tracheostomy

• Intensive Care Unit (ICU)
• Percutaneous endoscopic gastrostomy (PEG) placement
• interventional pulmonology

Percutaneous endoscopic gastrostomy (PEG) feeding provides enteral nutrition to patients with neurological dysphagia. However, the conditions in which PEG should be applied to prevent pneumonia remain unclear. We aimed to evaluate the effect of PEG for patients with neurological dysphagia in preventing pneumonia.

We undertook a retrospective data review of 232 patients with neurological dysphagia who had undergone PEG from January 2008 to December 2018 at Inha University Hospital, in Incheon, Korea. We excluded patients who had not been followed up 6 months pre- and post-PEG feeding. In total, our study comprised 42 patients. We compared pneumonia episodes and incidence pre- and post-PEG.

During the median post-PEG follow-up period, the 6-month pneumonia incidence among patients who had undergone PEG had decreased [median 0.3 (interquartile range (IQR) 0.0–0.7) versus 0.1 (IQR 0.1–0.3) episodes, p = 0.04]. In a multiple mixed model, PEG did not decrease the incidence of pneumonia (p = 0.76). However, the association between PEG and the incidence of pneumonia differed significantly depending on the presence or absence of recurrent pneumonia (p < 0.001).

PEG could effectively reduce the incidence of pneumonia in patients with neurogenic dysphagia, especially in those who had experienced recurrent pneumonia.

The reviews of this paper are available via the supplemental material section.

• dysphagia
• enteral nutrition
• gastrointestinal
• intubation
• nervous system disease
• percutaneous endoscopic gastrostomy
• pneumonia

Percutaneous endoscopic gastrostomy (PEG) is a popular method for long-term enteral feeding. Our aim was to determine potential risk factors for adverse events related to PEG, as well as consequent prolonged hospitalization.

Data were retrospectively collected from the admission records of a tertiary center between July 2015 and June 2018. Possible predictors of the 3 following outcomes were evaluated: minor PEG-related adverse events, major PEG-related adverse events, and length of hospital stay. Data were tested for correlation using the Spearman coefficient and for association using Kruskal-Wallis tests for significance.

A total of 362 admissions involving 146 patients were included in the study. Of the admissions, 221 (61.0%) had only minor adverse events, 100 (27.6%) had only major adverse events, and 41 (11.3%) had both. Eighty (22.1%) had PEG-site infection and 128 (35%) had aspiration pneumonia. Serum albumin levels at presentation were negatively correlated with the length of hospitalization (P<0.001), which also differed between patients presenting with major and minor adverse events (P<0.001 and P=0.026). The Charlson comorbidity index was positively correlated with the duration of hospitalization (P<0.001). Higher index scores were found more among patients presenting with aspiration pneumonia (P=0.004) and lower scores were found among patients presenting with PEG site infection and inadvertent PEG removal compared with those presenting with a major complication (P<0.001).

The patient’s general medical condition and nutritional status are the greatest risk predictors for developing adverse events related to their PEG feeding, as well as a consequent extended hospital stay.

• Charlson comorbidity index
• Percutaneous endoscopic gastrostomy
• albumin
• risk prediction

• Percutaneous endoscopic gastrostomy (PEG)
• cancer
• oesophagus

• Congenital heart disease
• Fundoplication
• Gastroesophageal reflux
• Gastrostomy

• Adolescent
• Child
• Interventional radiology
• Oncology
• Primary button gastrostomy
• Young adult

• Adolescent
• Adult
• Child
• Child, Preschool
• Feasibility Studies
• Female
• Gastrostomy/instrumentation
• Humans
• Male
• Neoplasms/complications
• Postoperative Complications
• Radiography, Interventional
• Retrospective Studies
• Treatment Outcome
• Young Adult

• Bumper migration
• Gastrostomy
• Gastrostomy tube replacement

AIM: To evaluate the inhibitory effects of carbon dioxide (CO₂) insufflation on pneumoperitoneum and bowel distension after percutaneous endoscopic gastrostomy (PEG).

METHODS: A total of 73 consecutive patients who were undergoing PEG were enrolled in our study. After eliminating 13 patients who fitted our exclusion criteria, 60 patients were randomly assigned to either CO₂ (30 patients) or air insufflation (30 patients) groups. PEG was performed by pull-through technique after three-point fixation of the gastric wall to the abdominal wall using a gastropexy device. Arterial blood gas analysis was performed immediately before and after the procedure. Abdominal X-ray was performed at 10 min and at 24 h after PEG to assess the extent of bowel distension. Abdominal computed tomography was performed at 24 h after the procedure to detect the presence of pneumoperitoneum. The outcomes of PEG for 7 d post-procedure were also investigated.

RESULTS: Among 30 patients each for the air and the CO₂ groups, PEG could not be conducted in 2 patients of the CO₂ group, thus they were excluded. Analyses of the remaining 58 patients showed that the patients’ backgrounds were not significantly different between the two groups. The elevation values of arterial partial pressure of CO₂ in the air group and the CO₂ group were 2.67 mmHg and 3.32 mmHg, respectively (P = 0.408). The evaluation of bowel distension on abdominal X ray revealed a significant decrease of small bowel distension in the CO₂ group compared to the air group (P < 0.001) at 10 min and 24 h after PEG, whereas there was no significant difference in large bowel distension between the two groups. Pneumoperitoneum was observed only in the air group but not in the CO₂ group (P = 0.003). There were no obvious differences in the laboratory data and clinical outcomes after PEG between the two groups.

CONCLUSION: There was no adverse event associated with CO₂ insufflation. CO₂ insufflation is considered to be safer and more comfortable for PEG patients because of the lower incidence of pneumoperitoneum and less distension of the small bowel.

• Percutaneous endoscopic gastrostomy
• Carbon dioxide insufflation
• Pneumoperitoneum
• Abdominal distension
• Randomized control study

• Child
• Child, Preschool
• Female
• Gastrostomy
• Humans
• Hydrocephalus/surgery
• Infant
• Male
• Postoperative Complications
• Prospective Studies
• Statistics, Nonparametric
• Surgical Wound Infection/etiology
• Ventriculoperitoneal Shunt
• Video-Assisted Surgery

• Clinical Competence/standards
• Enteral Nutrition
• Gastroenterology
• Gastroscopy/nursing
• Gastrostomy/nursing
• Humans
• Intubation, Gastrointestinal/nursing
• Jejunostomy/nursing
• Nurse's Role
• Personnel Delegation/organization & administration
• Professional Autonomy
• Specialties, Nursing/education
• Specialties, Nursing/organization & administration

• Female
• Follow-Up Studies
• Gastrostomy/methods
• Humans
• Infant
• Infant Nutrition Disorders/surgery
• Laparoscopy/methods
• Male
• Prospective Studies
• Treatment Outcome
• Video-Assisted Surgery

• Abdominal Wall/surgery
• Child
• Child, Preschool
• Device Removal
• Gastrostomy
• Humans
• Stomach/surgery
• Video-Assisted Surgery
• Wound Healing