Use of Noninvasive Ventilation During Feeding Tube Placement

Abstract

Parenteral nutrition is indicated in amyotrophic lateral sclerosis (ALS) when dysphagia, loss of appetite, and difficulty protecting the airways cause malnutrition, severe weight loss, dehydration, and increased risk of aspiration pneumonia. The aim of this review is to compare percutaneous endoscopic gastrostomy (PEG), radiologically inserted G-tube (RIG), and percutaneous radiologic gastrostomy (PRG) in patients with ALS, performed with or without noninvasive ventilation (NIV). We searched PubMed, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the EBSCO Online Research Database, and Scopus up to December 2015. A priori selection included all randomized controlled trials (RCTs), quasi-randomized trials, and prospective and retrospective studies. The primary outcome was 30-d survival. We found no RCTs or quasi-RCTs. Seven studies about the implementation of the PEG/RIG procedure during the use of NIV and 5 studies without NIV were included. In another study of 59 subjects undergoing open gastrostomy, all with vital capacity < 30% of normal, 18 of whom were dependent on continuous NIV at full ventilatory support settings, there were no respiratory complications. Thus, the use of NIV during the implementation of these procedures, especially when used at full ventilatory support settings of pressure preset 18-25 cm HO, can support alveolar ventilation before, during, and after the procedures and prevent respiratory complications. The procedures investigated appear equivalent, but the methodological quality of the studies could be improved. Possible benefits with regard to nutrition parameters, quality of life, and psychological features need to be further investigated.

Predictive factors for prognosis after gastrostomy placement in routine non-invasive ventilation users ALS patients

“…The indications for GP were a reduction of 5% or more of pre-onset weight, and/or severe dysphagia. The method of insertion-percutaneous endoscopic gastrostomy (PEG) or radiologically-inserted gastrostomy (RIG)-was decided by the referent neurologist 5 . RIG procedure was preferred for patients with a more compromised respiratory function whereas Figure 1.…”

How the Covid-19 epidemic is challenging our practice in clinical nutrition—feedback from the field

“…The total apnea time is much shorter during EN infusion than during a normal meal. In other types of dyspneic patients, such as those with amyotrophic lateral sclerosis and a vital capacity lower than 30% of the theoretical, with or without noninvasive ventilation, NGT insertion was perfectly possible, safe and not different from EN through a gastrostomy in terms of day 30 complications [53].…”

Noninvasive Respiratory Management of Patients With Neuromuscular Disease

“…When post-extubation oral intake is unsafe or inadequate and a gastrostomy tube is needed, this can be done without re-intubating the patient by interventional radiology [ 72 ], as an open gastrotomy by general surgery [ 73 ], or as a percutaneous endoscopic gastrostomy with the trochanter passed via an orifice in an oronasal interface that is also used to deliver NVS [ 71 74 ]. These approaches are summarized in my last book and in an updated version soon to be in press [ 75 76 ].…”