The Science Journal of the American Association for Respiratory Care
Percutaneous endoscopic gastrostomy (PEG) tube placement can be a life prolonging intervention for patients with amyotrophic lateral sclerosis (ALS). A percutaneous gastrostomy tube can reduce the potential for aspiration, provide increased nutritional support and improve the patient's quality of life. Because of the perceived risk of precipitating acute respiratory failure during conscious sedation for this procedure, some have suggested that significant impairment of vital capacity is a contra-indication to PEG tube placement. We describe the use of noninvasive positive pressure ventilation (NPPV) for respiratory support during conscious sedation for a PEG procedure in two ALS patients, one having severe bulbar symptoms. Inspiratory pressure and timed breath rate were adjusted to support the patient while monitoring electrocardiogram, oxygen saturation, estimated tidal volume and respiratory rate during the PEG procedure. The primary risk of NPPV is the lack of a secure airway during respiratory support of the PEG procedure with sedation. This technique requires both a physician and a respiratory care practitioner familiar with NPPV, as well as a patient fully acclimated to the use of NPPV. The use of NPPV as respiratory support for the placement of a percutaneous gastrostomy tube can increase the period of opportunity to perform the procedure in chronic neuromuscular patients with severe respiratory insufficiency.
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