Noninvasive ventilation during percutaneous endoscopic gastrostomy in neuromuscular patients with severe ventilatory impairment

Introduction: Percutaneous endoscopic gastrostomy (PEG) placement has a risk of respiratory failure in patients with neuromuscular diseases and severe ventilatory impairment (NMD/SVI). During the procedure noninvasive ventilation (NIV) might reduce this risk. Objective: Clinical and functional characterization of patients with NMD/SVI and indication for PEG, as well as to report safety and survival outcomes. Methods: Analysis of neuromuscular patients who had a SVI characterized by vital capacity (VC) Results: 52 patients included (63.5% females) with median(IQR) age of 68(59.5-74.8) years, 63.5%. The majority (94.2%) had amyotrophic lateral sclerosis (ALS) and the remaining Duchenne muscular dystrophy, multiple sclerosis and C4 spinal corde lesion. Bulbar impairment was the clinical presentation of ALS in 59.2% and at time of PEG placement was present in all patients. The VC was 800(580-1200) mL and peak cough flow (PCF) 100(0-160) mL. 96.2% patients were using NIV at home. Most (46%) were under continuous noninvasive ventilatory support (CNVS) and the remaining under nocturnal NIV (40%) and nocturnal with diurnal periods of NIV (14%). There weren9t immediate or respiratory complications during the procedure. Posterior occurrences: local infection in 5.8%, bleeding in 3.8% and displacement in 1.9%. During a 5 year follow-up, 75% of patients died, with a median survival of 9 months (0-45%), significantly higher in patients under CNVS ( p =0.01). Conclusion: In patients with NMD/SVI, NIV allows a successful PEG placement, without any respiratory complications and with direct impact on survival.