PTU-150 Non-invasive ventilation during percutaneous endoscopic gastrostomy insertion in motor neurone disease patients – a safe and effective multi-disciplinary approach

Abstract

Introduction Motor Neurone Disease is a fatal progressive neurodegenerative disorder of unknown aetiology. About 25 to 30% of all patients have bulbar symptoms as the presenting complaint. As dysphagia worsens, referral for Percutaneous Endoscopic Gastrostomy (PEG) feeding is increasingly common as an alternative or supplementary route for nutrition and hydration. There are concerns however regarding respiratory complications in this high risk group. The aim of this study was evaluate safety and efficacy of PEG placement using NIV cover in MND patients. Method We undertook a prospective study of MND patients who had PEG placement with NIV cover from January 2012 to April 2014. Our multi-disciplinary team comprised specialist nurses, respiratory consultants, gastroenterologists, neurologist, nutrition team, dietician and MND coordinator. All patients had initial respiratory assessment and were admitted to the ward a day prior to the procedure. NIV support was given using a nasal mask if needed. Patients stayed in overnight to facilitate instructions and care. Results 75 patients with motor neurone disease who had PEG inserted were included in the study. Median age at the time of PEG insertion was 67 years (range 38–88). Male to female ratio was 37:38. Mean FVC was 58% (range 22–89) and mean SNIP was -28 cm H 2 O (range 12–83). 47 of these 75 patients were ventilated only for the procedure, 3 only following the procedure. 11 patients were already on 24 h ventilation, 9 were on overnight ventilation, 2 were on >14 h ventilation and data was not available on 3 patients. Mean Charlson Co-morbidity index was 0.6. All PEG insertions were successful and none of the patients needed a RIG insertion. There was one patient who had bleeding post procedure which was conservatively managed. Another patient had a small bowel injury which needed a mini-laparotomy. This patient had an uneventful recovery. Hypoxia was a common occurrence but was corrected promptly with NIV. Intravenous sedation was appropriately titrated to avoid respiratory depression and to provide adequate sedation. Survival at 1 month was 97.3%. Conclusion PEG placement in high risk MND patients can be particularly challenging. It needs a multi-disciplinary approach. Our study has shown that high risk MND patients can have PEGs inserted safely with intensive support and monitoring. We do recognise however that there is a need for prospective studies in this field as well as need for studies comparing safety data between routine PEG insertion and PEG insertion with NIV support. Disclosure of interest None Declared.