Respiratory Therapists’ Role in Monitoring and Managing the ALS Patient During G-Tube Placement: Paving the Way for Airway Management With NIV During Conscious Sedation

Abstract

Background:

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease of the human motor system resulting in severe respiratory compromise due to loss of phrenic nerve function. FVC and MIP measurements are part of the most important diagnostic interventions taken to gauge the quality of life of ALS patients. An FVC of <50% is indicative of imminent respiratory failure including a higher risk of difficult extubation during invasive procedures requiring intubation. Therefore, minimal sedation and utilization of noninvasive ventilation (NIV) are recommended during procedures such as G-tube and port placements for ALS patients with FVC measurements of <50%. Respiratory therapist (RT) presence during the procedure is important due to risks for respiratory failure, pain, communication breakdown, and significant stress as a result of inappropriate or non-utilization of NIV leading to unnecessary intubations. Problem Statement: Considering minimal sedation and NIV utilization during G-tube placement in the IR, the efficiency in transition of care without the assistance from anesthesiologists was unknown; warranting a look at provider satisfaction with noninvasive airway management by RTs during the procedure.

Methods:

Active collaboration of outpatient multidisciplinary ALS team including IR personnel, and inpatient care team was accomplished to bring awareness to specifics of ALS treatment and care. Curricula was developed to educate all RTs on neuro-respiratory care to advocate appropriate care for ALS patients. Workflow was designed to allow RT presence during G-tube procedure in the IR including efficiency in communication via in-basket messaging in Epic and secure emailing system.

Results:

93% providers were extremely satisfied with RT inpatient care, with 7% reporting satisfied or somewhat satisfied. 100% provider satisfaction attained with RT presence during G-tube procedure in the IR with a convenience in scheduling rate of 3 (rated on a scale of 1-3). 100% of providers reported feeling satisfied with communication between RT and IR regarding patient safety and comfort.

Conclusions:

Active collaboration between inpatient and outpatient providers is essential to seamless transition of care for patients with neuromuscular diseases. This paves the way for full utilization of multidisciplinary experts and resources, including respiratory care practitioners. Next steps entail in-patient RT rotation through outpatient NMD clinics to maintain consistency in treatment and care through establishment of a uniformed care plan.