RT Journal Article
SR Electronic
T1 Percutaneous gastrostomy (PEG) insertion under general anaesthesia (GA) in ventilator-dependent patients with neuromuscular disease (NMD)
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P3850
VO 42
IS Suppl 57
A1 Alanna Hare
A1 Michelle Chatwin
A1 Matthew Hind
A1 Michael Polkey
A1 Simon Jordan
A1 Anita Simonds
YR 2013
UL http://erj.ersjournals.com/content/42/Suppl_57/P3850.abstract
AB Introduction: NMD patients often develop dysphagia and/or aspirate, becoming malnourished, exacerbating weakness. PEG tubes offer nutritional support. Previous studies report poor outcomes for PEG insertion under GA, particularly in patients with severe ventilatory failure.Aim: We examined outcomes of protocolised PEG insertion under GA for ventilator-dependent NMD patients.Methods: Retrospective case review of adult NMD patients with PEGs inserted in our hospital.Results: 27 patients identified:View this table:Protocol: PEG insertion under GA via gastroscope using “pull through” method. All patients (unless using T-IPPV) extubated onto NIV post-operatively and monitored for ≥1 night on ICU. All received dietetic input and physiotherapy, including use of cough-assist device. Outcomes: 8 complications: 3 local PEG site infections; 1 recurrent PEG blockage; 2 episodes transient abdominal distension on feeding; 2 pneumonias resolving with standard care. No NIV patients re-intubated; no deaths. All patients discharged from hospital. Median length of ICU stay: 1 (range 1-29) days; hospital stay 7 (range 2-121) days.Conclusion: In this group of ventilator-dependent NMD patients, PEG insertion under GA, early extubation to usual ventilatory support, and careful monitoring and multidisciplinary care in the post-operative period, proved safe and effective.