Noninvasive Mechanical Ventilation Improves Breathing-Swallowing Interaction of Ventilator Dependent Neuromuscular Patients: A Prospective Crossover Study

<div><p>Background</p><p>Respiratory involvement in neuromuscular disorders may contribute to impaired breathing-swallowing interactions, swallowing disorders and malnutrition. We investigated whether the use of non-invasive ventilation (NIV) controlled by the patient could improve swallowing performances in a population of neuromuscular patients requiring daytime NIV.</p><p>Methods</p><p>Ten neuromuscular patients with severe respiratory failure requiring extensive NIV use were studied while swallowing without and with NIV (while ventilated with a modified ventilator allowing the patient to withhold ventilation as desired). Breathing-swallowing interactions were investigated by chin electromyography, cervical piezoelectric sensor, nasal flow recording and inductive plethysmography. Two water-bolus sizes (5 and 10ml) and a textured yogurt bolus were tested in a random order.</p><p>Results</p><p>NIV use significantly improved swallowing fragmentation (defined as the number of respiratory interruption of the swallowing of a single bolus) (p = 0.003) and breathing-swallowing synchronization (with a significant increase of swallows followed by an expiration) (p <0.0001). Patient exhibited piecemeal swallowing which was not influenced by NIV use (p = 0.07). NIV use also significantly reduced dyspnea during swallowing (p = 0.04) while preserving swallowing comfort, regardless of bolus type.</p><p>Conclusion</p><p>The use of patient controlled NIV improves swallowing parameters in patients with severe neuromuscular respiratory failure requiring daytime NIV, without impairing swallowing comfort.</p><p>Trial Registration</p><p>ClinicalTrials.gov <a href="https://clinicaltrials.gov/ct2/show/NCT01519388" target="_blank">NCT01519388</a></p></div

Swallowing variables per bolus according to bolus type (5ml, 10ml, or yogurt) and test condition: during spontaneous breathing (SB) and with NIV.

<p>Swallowing variables per bolus according to bolus type (5ml, 10ml, or yogurt) and test condition: during spontaneous breathing (SB) and with NIV.</p

Patients characteristics.

<p>Patients characteristics.</p

CONSORT study flow diagram.

<p>CONSORT study flow diagram.</p

Representative example of EEG showing periodic discharges (PDs) in a septic ICU patient.

<p>See these spontaneous generalized repetitive discharges of spikes and bursts of sharp waves at nearly regular intervals and without evolution in location and morphology. Recording: 20 mm/sec, sensitivity: 10 μV/mm; filter settings: 0.500 Hz -70Hz.</p

Representative example of a non-reactive EEG following painful stimuli (pinching) in a septic ICU patient.

<p>No EEG background activity change was observed after the painful stimulation (pinching) Recording: 20 mm/sec, sensitivity: 10 μV/mm; filter settings: 0.500 Hz -70Hz.</p

EEG findings and classification.

<p>EEG findings and classification.</p

Prevalence of non-reactive EEG among different sub-groups of the studied septic ICU patients.

<p>Prevalence of non-reactive EEG among different sub-groups of the studied septic ICU patients.</p

Representative example of EEG showing the onset of an electrographic seizure (ESZ) in a septic ICU patient.

<p>See the onset of this spontaneous and sustained discharge of spikes and waves with changes in frequency and morphology. Recording: 20 mm/sec, sensitivity: 10 μV/mm; filter settings: 0.500 Hz -70Hz.</p

Flow chart of the recruited population.

<p>*: Systemic Inflammatory Response Syndrome.</p