Sonia Khirani1, Adriana Ramirez2, Vincent Delord3, Karl Leroux4, Frédéric Lofaso5, Solène Hautot6, Michel Toussaint7, David Orlikowski8, Bruno Louis9, Brigitte Fauroux10. 1. Pediatric Pulmonary Department, Assistance Publique-Hôpitaux de Paris, Hôpital Armand Trousseau, Paris, France. S2A Santé, Ivry sur Seine, France. 2. Pediatric Pulmonary Department, Assistance Publique-Hôpitaux de Paris, Hôpital Armand Trousseau, Paris, France. Association d'Entraide des Polios et Handicapés Assistance, Suresnes, France. 3. ASV Santé, Gennevilliers, France. 4. Association d'Entraide des Polios et Handicapés Assistance, Suresnes, France. 5. Physiologie-Explorations Fonctionnelles, Services de Réanimation Médicale, and the Centre d'Innovations Technologiques Unité Mixte de Recherche 805, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France, and EA 4497, Université de Versailles, Saint-Quentin-en-Yvelines, France. Institut National de la Santé et de la Recherche Médicale U955, Université Paris Est, Faculté de Médecine, Centre National de la Recherche Scientifique ERL 7240, Créteil, France. 6. IBIOM, Ingénierie pour le Biomédical, Faculté des Sciences et Techniques, Université de Rouen, Saint-Étienne du Rouvray, France. 7. Neuromuscular Excellence Center, VUB-Inkendaal, and the Center for Home Mechanical Ventilation, Z.H. Inkendaal Rehabilitation Hospital, Brussels, Belgium. 8. Service de Réanimation Médicale, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France, and the Université de Versailles, Saint-Quentin-en-Yvelines, France. 9. Institut National de la Santé et de la Recherche Médicale U955, Université Paris Est, Faculté de Médecine, Centre National de la Recherche Scientifique ERL 7240, Créteil, France. 10. Pediatric Pulmonary Department, Assistance Publique-Hôpitaux de Paris, Hôpital Armand Trousseau, Paris, France. Institut National de la Santé et de la Recherche Médicale U955, Université Paris Est, Faculté de Médecine, Centre National de la Recherche Scientifique ERL 7240, Créteil, France. Université Pierre et Marie Curie-Paris 6, Paris, France. brigitte.fauroux@nck.aphp.fr.
Abstract
BACKGROUND: Daytime mouthpiece ventilation is a useful adjunct to nocturnal noninvasive ventilation (NIV) in patients with neuromuscular disease. The aims of the study were to analyze the practice of mouthpiece ventilation and to evaluate the performance of ventilators for mouthpiece ventilation. METHODS: Practice of mouthpiece ventilation was assessed by a questionnaire, and the performance of 6 home ventilators with mouthpiece ventilation was assessed in a bench test using 24 different conditions per ventilator: 3 mouthpieces, a child and an adult patient profile, and 4 ventilatory modes. RESULTS: Questionnaires were obtained from 30 subjects (mean age 33 ± 11 y) using NIV for 12 ± 7 y. Fifteen subjects used NIV for > 20 h/day, and 11 were totally ventilator-dependent. The subject-reported benefits of mouthpiece ventilation were a reduction in dyspnea (73%) and fatigue (93%) and an improvement in speech (43%) and eating (27%). The bench study showed that none of the ventilators, even those with mouthpiece ventilation software, were able to deliver mouthpiece ventilation without alarms and/or autotriggering in each condition. Alarms and/or ineffective triggering or autotriggering were observed in 135 of the 198 conditions. The occurrence of alarms was more common with a large mouthpiece without a filter compared to a small mouthpiece with a filter (P < .001), but it was not related to the patient profile, the ventilatory mode, or the type of ventilator. CONCLUSIONS: Subjects are satisfied with mouthpiece ventilation. Alarms are common with home ventilators, although less common in those with mouthpiece ventilation software. Improvements in home ventilators are needed to facilitate the expansion of mouthpiece ventilation.
BACKGROUND: Daytime mouthpiece ventilation is a useful adjunct to nocturnal noninvasive ventilation (NIV) in patients with neuromuscular disease. The aims of the study were to analyze the practice of mouthpiece ventilation and to evaluate the performance of ventilators for mouthpiece ventilation. METHODS: Practice of mouthpiece ventilation was assessed by a questionnaire, and the performance of 6 home ventilators with mouthpiece ventilation was assessed in a bench test using 24 different conditions per ventilator: 3 mouthpieces, a child and an adult patient profile, and 4 ventilatory modes. RESULTS: Questionnaires were obtained from 30 subjects (mean age 33 ± 11 y) using NIV for 12 ± 7 y. Fifteen subjects used NIV for > 20 h/day, and 11 were totally ventilator-dependent. The subject-reported benefits of mouthpiece ventilation were a reduction in dyspnea (73%) and fatigue (93%) and an improvement in speech (43%) and eating (27%). The bench study showed that none of the ventilators, even those with mouthpiece ventilation software, were able to deliver mouthpiece ventilation without alarms and/or autotriggering in each condition. Alarms and/or ineffective triggering or autotriggering were observed in 135 of the 198 conditions. The occurrence of alarms was more common with a large mouthpiece without a filter compared to a small mouthpiece with a filter (P < .001), but it was not related to the patient profile, the ventilatory mode, or the type of ventilator. CONCLUSIONS: Subjects are satisfied with mouthpiece ventilation. Alarms are common with home ventilators, although less common in those with mouthpiece ventilation software. Improvements in home ventilators are needed to facilitate the expansion of mouthpiece ventilation.
Authors: Giuseppe Fiorentino; Anna Annunziata; Rosa Cauteruccio; Gianfranco Scotto di Frega; Antonio Esquinas Journal: J Bras Pneumol Date: 2016 Nov-Dec Impact factor: 2.624