EVIDENCE LIBRARY
PEG placement with NIV in severe ALS: midazolam was part of a supported procedure
A retrospective series reported successful gastrostomy under noninvasive ventilation, often with mild midazolam sedation.
A retrospective series reported successful gastrostomy under noninvasive ventilation, often with mild midazolam sedation.
What the series recorded
The study included 59 patients with amyotrophic lateral sclerosis and severe ventilatory impairment. All underwent gastrostomy placement with noninvasive ventilation; approximately 80% received mild midazolam sedation. No immediate aspiration, intubation, or procedure-related mortality was reported.
The intervention included respiratory support and an interdisciplinary procedural team. The outcome therefore describes that supported pathway rather than midazolam administration in isolation.
Zero observed events does not mean zero risk
The retrospective sample was small and had no randomized alternative-sedation comparison. It cannot establish that all patients with severe respiratory weakness tolerate benzodiazepines or quantify very rare complications. Later disease outcomes are also distinct from immediate procedural safety.
For an individual review, document ventilation settings, sedation depth, staff support, and recovery alongside drug exposure. The paper supports feasibility in an experienced setting while leaving comparative safety and broader applicability uncertain.
Source paper
Original analysis of the supplied journal article, identified as PMC9891146.