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Nutrition clinique et métabolisme
Volume 14, n° 2
pages 135-137 (juin 2000)
Doi : S0985-0562(00)80072-2
La gastrostomie percutanée endoscopique en réanimation
Percutaneous endoscopic gastrostomy in intensive care
 

Jean-Pierre Fulgencio
 Départment d'anesthésie-réanimation chirurgicale, hôpital Tenon, 4, rue de la Chine, 75790 Paris cedex 20, France 

Résumé

L'indication de la nutrition artificielle en rénimation se justifie par l'incapacité des patients à assurer leurs besoins nutritionnels, qu'ils se trouvent ou non dans un coma spontané ou thérapeutique. Les bénéfices potentiels de la voie entérale la font actuellement préférer à la voie parentérale, mais l'abord digestif pose des problèmes mécaniques et infectieux (sinusites, pneumopathies). De plus, l'abord gastrique, le plus simple et le plus utilisé, se heurte à l'existence fréquente d'une gastroparésie. Un moyen de contourner l'obstacle consiste à positionner la sonde en post-pylorique. La gastrostomie percutanée endoscopique (GPE) est une alternative à l'abord gastrique à travers la sphère ORL, permettant potentiellement de diminuer la fréquence des sinusites, d'accéder au site post-pylorique à travers la GPE et d'anticiper la prise en charge nutritionnelle après la réanimation. C'est ainsi que les études sur la GPE en réanimation concernent essentiellement des patients traumatisés crâniens ou de neurologie soumis à une nutrition artificielle prolongée.

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Summary

Nutrition support is mandatory in intensive care as patients, comatose or not, can't assume their daily dietary allowances. Currently, enteral nutrition is preferred to parenteral nutrition for its infectious and metabolic advantages. But enteral catheterisation yields mechanical and infectious problems (sinusitis, pneumonia). Furthermore, besides its ease of use, gastric nutrition must overcome acute gastric paralysis, unless the stomach is shunted by post-pyloric feeding. As an alternative to enteric feeding via the aero-digestive tract, percutaneous endoscopic gastrostomy (PEG) can potentially decrease the incidence of sinusitis and enable to bypass the pylorus. Its utilisation may overcome alimentation difficulties from intensive care to rehabilitation wards as it is a non removable means of feeding. As such, studies of PEG in intensive care mostly include closed head injury and neurological patients under prolonged artificial nutrition.

The full text of this article is available in PDF format.

Keywords : complications, nutrition entérale

Keywords : complications, enteral nutrition




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