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

Additional file 1: of Outcomes of patients admitted to intensive care units for acute manifestation of small-vessel vasculitis: a multicenter, retrospective study

Outcome of patients admitted to the ICU for acute manifestation of small-vessel vasculitis. (DOCX 23 kb

Survival curves at day 90 according to corticosteroids therapy for AECOPD at admission in ICU (n = 863).

Effects of corticosteroids in survival analysis (cox model) for 90-day survival: HR = 0.79 [0.6; 1.06], p = 0.121. (DOCX)</p

Ventilatory support used for patients admitted in ICU for a severe AECOPD.

ICU: Intensive Care Unit. NIV: Non-Invasive Ventilation. IMV: Invasive Mechanical Ventilation. (DOCX)</p

Summary of results for corticosteroids therapy and ventilator-free days.

All patients and sub-groups of patients. VFD at day 28 is express in Median and interquartiles of days, Median [Q1; Q3]. IRR: Incidence Rate Ratio. VFD: Ventilator-free days. IMV: Invasive Mechanical Ventilation. NIV: Non-Invasive Ventilation. (DOCX)</p

Double Robust Analysis of the association between prescription of corticosteroids at admission in ICU for AECOPD and in-hospital death.

Adjustment also performed on centre and year. Survival analysis performed with a cox model. ICU: Intensive Care Unit. AECOPD: Acute exacerbation of chronic obstructive pulmonary disease. COPD: Chronic Obstructive Pulmonary Disease. BMI: Body Mass Index. SOFA: Sequential Organ Failure Assessment. Pa02: Partial pressure of oxygen. FiO2: Fraction of inspired oxygen. NIV: Non-Invasive Ventilation. IMV: Invasive Mechanical Ventilation. (DOCX)</p

Survival curves at day 28 according to corticosteroid therapy for AECOPD at admission in ICU.

Effects of corticosteroids on survival analysis (Cox model) for 28-day survival: HR = 0,89 [0.64; 1.24], p = 0.497. (DOCX)</p