Abstract Introduction Bedside tracheostomy and percutaneous gastrostomy (T-PUG) performed by critical care medicine (CCM) provides an efficient alternative to traditional surgical workflows, enabling timely airway and enteral access in the ICU without timely delays. Prior studies suggest that bedside interventions may reduce ICU and hospital length of stay, resource utilization, and costs. Evaluating the safety, coordination, and efficiency of T-PUG is critical for optimizing care in critically ill patients and identifying opportunities to enhance workflow. Case Series Five critically ill patients underwent bedside tracheostomy by CCM followed by PUG or traditional percutaneous endoscopic gastrostomy (PEG) by gastroenterology (GI). PUG by CCM was completed within one hour of tracheostomy with no procedural complications, whereas GI placed PEG occurred 21-233 hours after bedside tracheostomy and was associated with complications and prolonged hospital stays. Case 1: 53-year-old male with cardiac arrest; underwent bedside tracheostomy followed by PEG 21 hours later. Minor bleeding occurred and was managed conservatively. ICU/hospital stay: 16 days each. Case 2: 57-year-old male with hypertensive intracerebral hemorrhage; underwent bedside tracheostomy followed by failed attempt at PUG, and eventual PEG at 233 hours due to hypernatremia and fever. ICU/hospital stay: 24 and 42 days. Case 3: 69-year-old male with heart failure exacerbation and pneumonia; bedside tracheostomy followed by PEG 46 hours later, complicated by bile reflux. ICU/hospital stay: 17 days each. Case 4: 61-year-old male with metabolic encephalopathy and respiratory failure; T-PUG performed with no documented complications. ICU/hospital stay: 21 and 23 days. Case 5: 82-year-old female with cerebrovascular accident and pneumonia; T-PUG performed with no documented complications. ICU/hospital stay: 15 and 19 days. Discussion Patients receiving T-PUG by CCM had shorter ICU and hospital stays without complications, whereas T-PEG was associated with procedural delays and longer hospitalization (average ICU stay 19 vs 18 days; hospital stay 25 vs 21 days). These findings align with prior reports that bedside gastrostomy by CCM teams can reduce length of stay and costs. Coordinated bedside airway and enteral access appears to improve efficiency, reduce resource burden, and optimize workflow in critically ill patients. Although our study is limited by a small sample size, single-center retrospective design, and reliance on provider documentation, future work could prospectively compare larger cohorts, include cost analyses, and explore implementation strategies to support wider adoption of combined bedside procedures by CCM. This abstract is funded by: None
Karmilkar et al. (Fri,) studied this question.