title: Noninvasive ventilation during gastrostomy tube placement in patients with severe duchenne muscular dystrophy: case reports and review of the literature.
abstract: Individuals with Duchenne muscular dystrophy may benefit from gastrostomy tube feeding due to progressive dysphagia and malnutrition. However, due to their severely impaired pulmonary function, these individuals are at risk of severe complications when they are sedated or undergo anesthesia for the procedure. We previously described a technique of noninvasive positive pressure ventilation to provide respiratory support during gastrostomy tube placement in such patients, but this technique had risks and limitations. In this case report, we examine two alternative techniques we used to provide respiratory support successfully to patients with severe muscular dystrophy and malnutrition who underwent percutaneous endoscopic gastrostomy tube placement. We then review the literature and discuss the potential benefits, risks, and limitations of the above techniques and of other options for gastrostomy placement in people with severe muscular dystrophy.
authors.affiliation: Department of Pediatrics, MetroHealth Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio 44109, USA. dbirnkrant@metrohealth.org
authors.forename: D J
authors.initials: DJ
authors.lastname: Birnkrant
authors.forename: R D
authors.initials: RD
authors.lastname: Ferguson
authors.forename: J E
authors.initials: JE
authors.lastname: Martin
authors.forename: G J
authors.initials: GJ
authors.lastname: Gordon
mesh_terms: D000328:Adult; D005500:Follow-Up Studies; D005774:Gastrostomy; D006801:Humans; D017214:Laryngeal Masks; D008297:Male; D020388:Muscular Dystrophy, Duchenne / Q000628:therapy*; D011175:Positive-Pressure Respiration / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index