P50 Effectiveness of an NIV Mask Adaptation, in reducing post-gastrectomy critical care utilisation. (11th November 2022)

• Record Type: Journal Article
• Authors: Madhu, Y; Messer, B
• Is Part Of: Thorax. Volume 77(2022)Supplement 1
• Page Start: A109
• Page End: A109
• Publication Date: 2022-11-11
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thorax-2022-BTSabstracts.186
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Objective: Many patients receiving long term ventilation (LTV) also require long-term nutritional support via a gastrostomy. Though gastrostomy insertion is a safe, and well-tolerated procedure, it can compromise ventilation due to positioning and sedation. General anaesthesia (GA) is high risk in these patients and may require critical care admission post-GA. Nasal non-invasive ventilation (NIV) during the procedure can be challenging due to leaks. To facilitate gastrostomy insertion whilst delivering safe NIV, we used a bronchoscopy elbow for endoscopic access as an adaptation to the NIV mask (adapted face mask). This study reports the development of our service in delivering ventilatory support during gastrostomy placement and to determine if this adaptation helped in reducing the complications. Method: We reviewed the gastrostomy database and electronic records of 77 patients, who had gastrostomy in 2014 – 2022. Since the use of the bronchoscopy elbow was introduced in 2017, the analysis was done for two time periods: 2014 to 2016 (Cohort 1) and 2017–2022 (Cohort 2). We compared the procedures performed during the two time periods. Results: The study population comprised of 26 patients in Cohort 1 and 51 patients in Cohort 2. The diagnoses included Motor Neurone Disease (45), Congenital muscle disease (25), and other (7) In cohort 1 and 2, 16/26 (62%) and 18/51 (35%) respectively required HDU admission for monitoring. Complications were rare in both cohorts and included: pneumonia (4), malpositioning (1), dislocated jaw (1), failure of procedure (1) and pneumothorax from nasogastric tube placement (1). Conclusion: From this study, we found that by using this simple adaptation, gastrostomy insertion procedures could be performed more commonly with sedation. This has reduced post-procedure HDU use making it more cost-effective.