title: Noninvasive respiratory muscle aids during PEG placement in ALS patients with severe ventilatory impairment.
abstract: Although no clear recommendations are given about when percutaneous endoscopic gastrostomy (PEG) should be placed in amyotrophic lateral sclerosis (ALS) patients, some experts underline the risk of respiratory complications when patients had severe ventilatory muscle impairment (SVMI).
  
  
  OBJECTIVE
  To evaluate the efficacy of noninvasive ventilation (NIV) and mechanically assisted cough (MAC) to avoid respiratory complications related to PEG placement in ALS patients with SVMI.
  
  
  METHODS
  Prospective study including ALS patients who had chosen to have PEG placement timed by swallowing dysfunction with the aid of NIV and MAC if needed. PEG was carried out under volume-cycled NIV through a nasal mask. MAC was applied prior to and at the end of the procedure.
  
  
  RESULTS
  Thirty ALS patients (60.43±12.03years) were included. Prior to PEG placement: BMI 25.0±4.6kg/m(2), ALSRFS-R 19.5±5.0, Norris bulbar sub-score 15.1±6.6, %FVC 35.9±18.1%, PCF 2.3±1.2L/s, PImax -35.6±24.6cmH(2)O, and PEmax 40.5±23.9cmH(2)O. Three patients had PEG placement under tracheotomy ventilation because NIV SpO(2) was below 88%. No patient died during the procedure nor did any have respiratory complications. Survival at 1month was 100%.
  
  
  CONCLUSIONS
  Respiratory support provided by volume-cycled NIV and MAC permits successful PEG placement in most ALS patients with SVMI.
authors.affiliation: Respiratory Care Unit, Respiratory Medicine Department, Hospital Clínico Universitario, Fundación para la Investigación HCUV-INCLIVA, Valencia, Spain; Universitat de Valencia, Spain. cchinesta@eresmas.com
authors.forename: Jesús
authors.initials: J
authors.lastname: Sancho
authors.forename: Emilio
authors.initials: E
authors.lastname: Servera
authors.forename: Eusebi
authors.initials: E
authors.lastname: Chiner
authors.forename: Pilar
authors.initials: P
authors.lastname: Bañuls
authors.forename: Elia
authors.initials: E
authors.lastname: Gómez-Merino
authors.forename: José N
authors.initials: JN
authors.lastname: Sancho-Chust
authors.forename: Julio
authors.initials: J
authors.lastname: Marín
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000601:surgery*; D015992:Body Mass Index; D003371:Cough / Q000209:etiology; D005260:Female; D005773:Gastroscopy / Q000009:adverse effects*; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012120:Respiration Disorders / Q000209:etiology* / Q000473:pathology; D012129:Respiratory Function Tests / Q000379:methods; D012132:Respiratory Muscles / Q000473:pathology / Q000601:surgery; D014139:Tracheostomy / Q000009:adverse effects*; D014797:Vital Capacity / Q000502:physiology