Hélène Prigent1, Marine Garguilo2, Sophie Pascal2, Samuel Pouplin2, Justine Bouteille2, Michèle Lejaille2, David Orlikowski2, Frédéric Lofaso2,3. 1. Services de Physiologie, Explorations Fonctionnelles, Réanimation Médicale, Rééducation Fonctionnelle, et Centre d'Investigation Clinique et d'Innovation Technologique (Inserm Unit 805), Hôpital Raymond Poincaré, AP-HP, 92380, Garches, France. helene.prigent@rpc.ap-hop-paris.fr. 2. Services de Physiologie, Explorations Fonctionnelles, Réanimation Médicale, Rééducation Fonctionnelle, et Centre d'Investigation Clinique et d'Innovation Technologique (Inserm Unit 805), Hôpital Raymond Poincaré, AP-HP, 92380, Garches, France. 3. Inserm U 955, Créteil, France.
Abstract
PURPOSE: Many patients with respiratory failure related to neuromuscular disease receive chronic invasive ventilation through a tracheostomy. Improving quality of life, of which speech is an important component, is a major goal in these patients. We compared the effects on breathing and speech of low-level positive end-expiratory pressure (PEEP, 5 cmH(2)O) and of a Passy-Muir speaking valve (PMV) during assist-control ventilation. METHODS: We studied ten patients with neuromuscular disorders, between December 2008 and April 2009. Flow was measured using a pneumotachograph. Microphone speech recordings were subjected to both quantitative measurements and qualitative assessments; the latter consisted of both an intelligibility score (using a French adaptation of the Frenchay Dysarthria Assessment) and a perceptual score determined by two speech therapists. RESULTS: Text reading time, perceptive score, intelligibility score, speech comfort, and respiratory comfort were similar with PEEP and PMV. During speech with 5 cmH(2)O PEEP, six of the ten patients had no return of expiratory gas to the expiratory line and, therefore, had the entire insufflated volume available for speech, a condition met during PMV use in all patients. During speech, the respiratory rate increased by at least 3 cycles/min above the backup rate in seven patients with PEEP and in none of the patients with PMV. CONCLUSIONS: Low-level PEEP is as effective as PMV in ensuring good speech quality, which might be explained by sealed expiratory line with low-level PEEP and/or respiratory rate increase during speech with PEEP observed in most of the patients.
PURPOSE: Many patients with respiratory failure related to neuromuscular disease receive chronic invasive ventilation through a tracheostomy. Improving quality of life, of which speech is an important component, is a major goal in these patients. We compared the effects on breathing and speech of low-level positive end-expiratory pressure (PEEP, 5 cmH(2)O) and of a Passy-Muir speaking valve (PMV) during assist-control ventilation. METHODS: We studied ten patients with neuromuscular disorders, between December 2008 and April 2009. Flow was measured using a pneumotachograph. Microphone speech recordings were subjected to both quantitative measurements and qualitative assessments; the latter consisted of both an intelligibility score (using a French adaptation of the Frenchay Dysarthria Assessment) and a perceptual score determined by two speech therapists. RESULTS: Text reading time, perceptive score, intelligibility score, speech comfort, and respiratory comfort were similar with PEEP and PMV. During speech with 5 cmH(2)O PEEP, six of the ten patients had no return of expiratory gas to the expiratory line and, therefore, had the entire insufflated volume available for speech, a condition met during PMV use in all patients. During speech, the respiratory rate increased by at least 3 cycles/min above the backup rate in seven patients with PEEP and in none of the patients with PMV. CONCLUSIONS: Low-level PEEP is as effective as PMV in ensuring good speech quality, which might be explained by sealed expiratory line with low-level PEEP and/or respiratory rate increase during speech with PEEP observed in most of the patients.
Authors: Massimo Antonelli; Elie Azoulay; Marc Bonten; Jean Chastre; Giuseppe Citerio; Giorgio Conti; Daniel De Backer; Herwig Gerlach; Goran Hedenstierna; Michael Joannidis; Duncan Macrae; Jordi Mancebo; Salvatore M Maggiore; Alexandre Mebazaa; Jean-Charles Preiser; Jerôme Pugin; Jan Wernerman; Haibo Zhang Journal: Intensive Care Med Date: 2011-02-03 Impact factor: 17.440
Authors: Eric Verin; Capucine Morelot-Panzini; Jesus Gonzalez-Bermejo; Benoit Veber; Brigitte Perrouin Verbe; Brigitte Soudrie; Anne Marie Leroi; Jean Paul Marie; Thomas Similowski Journal: ERJ Open Res Date: 2017-11-20