Noninvasive respiratory muscle aids during PEG placement in ALS patients with severe ventilatory impairment

Sancho, Jesús; Servera, Emilio; Chiner, Eusebi; Bañuls, Pilar; Gómez-Merino, Elia; Sancho-Chust, José N.; Marín, Julio

doi:10.1016/j.jns.2010.06.022

Cited by 39 publications

(26 citation statements)

References 26 publications

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“…Loss of 10% of UBW is the threshold for placement 51 . NIV during the PEG procedure may be feasible in patients with respiratory compromise 52 …”

Section: Risk Factors For Malnutrition In Amyotrophic Lateral Sclerosmentioning

confidence: 99%

Nutrition Management of Amyotrophic Lateral Sclerosis

Greenwood

2013

Nut in Clin Prac

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Amyotrophic lateral sclerosis (ALS) is a progressive neurological disease with high risk of malnutrition. Symptoms of dysphagia, depression, cognitive impairment, difficulty with self-feeding and meal preparation, hypermetabolism, anxiety, respiratory insufficiency, and fatigue with meals increase the risk of malnutrition. Malnutrition negatively affects prognosis and quality of life, making early and frequent nutrition assessment and intervention essential. Implementation of an adequate calorie diet, dietary texture modification, use of adaptive eating utensils, and placement of a feeding tube aid in preventing malnutrition. When nutrition status is compromised by dysphagia and weight loss (5%-10% of usual body weight) or body mass index <20 kg/m(2) without weight loss and when forced vital capacity is >50%, a percutaneous endoscopic gastrostomy placement is indicated. When forced vital capacity is <50%, a radiologically inserted gastrostomy is the preferred means of enteral placement due to lessened aspiration and respiratory risk. Parenteral nutrition (PN) is indicated only when enteral nutrition (EN) is contraindicated or impossible. This article reviews the background of ALS, nutrition implications and risk of malnutrition, treatment strategies to prevent malnutrition, the role of EN and PN, and feeding tube placement methods according to disease stage.

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“…Loss of 10% of UBW is the threshold for placement 51 . NIV during the PEG procedure may be feasible in patients with respiratory compromise 52 …”

Section: Risk Factors For Malnutrition In Amyotrophic Lateral Sclerosmentioning

confidence: 99%

Nutrition Management of Amyotrophic Lateral Sclerosis

Greenwood

2013

Nut in Clin Prac

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“…Several case series have reported that this is safe in patients with ALS and DMD. [123][124][125][126][127][128][129][130] Alternatively, the patient can be intubated for the procedure and extubated to NIV.…”

Section: Neuromuscular Diseasementioning

confidence: 99%

The Growing Role of Noninvasive Ventilation in Patients Requiring Prolonged Mechanical Ventilation

Hess

2012

Respir Care

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For many patients with chronic respiratory failure requiring ventilator support, noninvasive ventilation (NIV) is preferable to invasive support by tracheostomy. Currently available evidence does not support the use of nocturnal NIV in unselected patients with stable COPD. Several European studies have reported benefit for high intensity NIV, in which setting of inspiratory pressure and respiratory rate are selected to achieve normocapnia. There have also been studies reporting benefit for the use of NIV as an adjunct to exercise training. NIV may be useful as an adjunct to airway clearance techniques in patients with cystic fibrosis. Accumulating evidence supports the use of NIV in patients with obesity hypoventilation syndrome. There is considerable observational evidence supporting the use of NIV in patients with chronic respiratory failure related to neuromuscular disease, and one randomized controlled trial reported that the use of NIV was life-prolonging in patients with amyotrophic lateral sclerosis. A variety of interfaces can be used to provide NIV in patients with stable chronic respiratory failure. The mouthpiece is an interface that is unique in this patient population, and has been used with success in patients with neuromuscular disease. Bi-level pressure ventilators are commonly used for NIV, although there are now a new generation of intermediate ventilators that are portable, have a long battery life, and can be used for NIV and invasive applications. Pressure support ventilation, pressure controlled ventilation, and volume controlled ventilation have been used successfully for chronic applications of NIV. New modes have recently become available, but their benefits await evidence to support their widespread use. The success of NIV in a given patient population depends on selection of an appropriate patient, selection of an appropriate interface, selection of an appropriate ventilator and ventilator settings, the skills of the clinician, the motivation of the patient, and the support of the family.

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“…Among them, 258 subjects used NIV during the tube placement procedure, whereas 546 subjects did not. Among those who used NIV during the tube placement, 25 subjects were ongoing NIV users for 11 Ϯ 5.6 h/d, 35 19 subjects for Ͼ 4 h/d, 32 and 5 subjects for a mean of 5 Ϯ 3.3 h/d. 3 In 2 other studies, 17 and 81 subjects used NIV without indication of daily hours of use.…”

Section: Study Design and Participantsmentioning

confidence: 99%

Use of Noninvasive Ventilation During Feeding Tube Placement

et al. 2017

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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.

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Noninvasive respiratory muscle aids during PEG placement in ALS patients with severe ventilatory impairment

Cited by 39 publications

References 26 publications

Nutrition Management of Amyotrophic Lateral Sclerosis

Nutrition Management of Amyotrophic Lateral Sclerosis

The Growing Role of Noninvasive Ventilation in Patients Requiring Prolonged Mechanical Ventilation

Use of Noninvasive Ventilation During Feeding Tube Placement

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