TY - JOUR T1 - Non-invasive ventilatory (NIV) support for percutaneous endoscopic gastrostomy (PEG) tube insertion in patients with degenerative neuromuscular disease JF - European Respiratory Journal JO - Eur Respir J VL - 44 IS - Suppl 58 SP - P4709 AU - Stephanie Hobbins AU - Heidi Jew AU - Caroline Davies AU - Nicola Wootton AU - Alban Tanajura AU - Karen Morrison AU - Hardev Pall AU - Rachel Cooney AU - Nazim Nathani Y1 - 2014/09/01 UR - http://erj.ersjournals.com/content/44/Suppl_58/P4709.abstract N2 - IntroductionDegenerative neuromuscular disease with or without bulbar involvement results in respiratory muscle weakness and poor nutrition. Placing PEG tubes can compromise ventilation due to supine positioning, sedation, procedure anxiety and pooling of secretions. We provide a regional PEG placement with NIV support service and here review its outcomes.MethodA retrospective case review of 35 patients referred between 2011-13.A dual-limb non-invasive ventilator with inbuilt oxygen sensor was used. Mask adaptation allowed use of a tracheal mount with entrailed endoscope thus ensuring full face mask interface. Patients had a 30minute NIV introduction pre-procedure.Results26 patients successfully underwent PEG insertion with NIV whilst 6 did not require NIV. 27 patients were given sedation. 2 had laryngeal spasm preventing completion in one and another settled with positioning and increased NIV. 1 procedure was abandoned due to anatomical abnormality.Pre procedure SNIP ranged from 9-56, pO2 88-97% on room air and oxygen desaturation index from <1 to 37. Desaturation during the procedure (pO2 <85% on NIV and oxygen) was not related to measures of respiratory weakness or use of sedation.ConclusionNIV supported PEG placement remains a safe and effective service in patients with degenerative neuromuscular disease and respiratory muscle weakness.Full face interface during the procedure is possible with mask adaptation. Although air leak is unavoidable, successful ventilation can be achieved using higher pressures and tidal volumes and entrailed oxygen. A robust multidisciplinary pathway is mandatory along with a skilled endoscopist. ER -