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Noninvasive Ventilation and Breathing-Swallowing Interplay in Chronic Obstructive Pulmonary Disease*

Terzi, Nicolas MD, PhD1,2,3; Normand, Hervé MD, PhD1; Dumanowski, Edith4; Ramakers, Michel MD5; Seguin, Amélie MD3; Daubin, Cédric MD3; Valette, Xavier MD3; Masson, Romain MD3; Sauneuf, Bertrand MD3; Charbonneau, Pierre MD, PhD3; du Cheyron, Damien MD, PhD3,6; Lofaso, Frédéric MD, PhD7,8

doi: 10.1097/CCM.0b013e3182a66b4a
Clinical Investigations

Objectives: To investigate breathing-swallowing interactions in patients with chronic obstructive pulmonary disease requiring noninvasive mechanical ventilation and, if needed, to develop a technical modification of the ventilator designed to eliminate ventilator insufflations during swallowing.

Design: We conducted a prospective, open-label, interventional study.

Patients: Fifteen consecutive chronic obstructive pulmonary disease patients with exacerbations requiring ICU admission and NIV.

Interventions: Swallowing performance and breathing-swallowing interactions were investigated noninvasively by chin electromyography, cervical piezoelectric sensor, and inductive respiratory plethysmography. Two water-bolus sizes (5 and 10 mL) were tested in random order. Swallowing was tested with and without noninvasive mechanical ventilation, in random order. First, a standard mechanical ventilator capable of delivering noninvasive mechanical ventilation was used. Second, a marketed device was equipped with an off-switch for use during swallowing.

Measurements and Main Results: Swallowing performance and breathing-swallowing interactions were investigated noninvasively by chin electromyography, cervical piezoelectric sensor, and inductive respiratory plethysmography. Two water bolus sizes (5 and 10 mL) were tested in random order. Swallowing was tested with and without noninvasive mechanical ventilation in random order. First, a standard mechanical ventilator capable of delivering noninvasive mechanical ventilation was used. Swallowing efficiency, breathing-swallowing synchronization, and Borg Scale dyspnea scores improved significantly with noninvasive mechanical ventilation. However, swallowing induced ventilator triggering followed by autotriggering. To improve patient-ventilator synchrony, a marketed device was equipped with an off-switch for use during swallowing. This device completely eliminated swallowing-induced ventilator triggering and postswallow autotriggering.

Conclusion: Patients with chronic obstructive pulmonary disease admitted to the ICU for acute exacerbations had abnormal breathing-swallowing interactions and dyspnea, which improved with noninvasive mechanical ventilation. Furthermore, a ventilator device with a simple switch-off pushbutton to eliminate insufflations during swallows prevented swallowing-induced ventilator triggering and postswallow autotriggering.

1Inserm, U 1075 COMETE, Caen, 14032, France.

2UCBN, COMETE, Caen, 14032, France.

3Service de Réanimation Médicale, CHRU, Caen, France.

4Service d’Explorations Fonctionnelles Respiratoire, CHRU, Caen, France.

5Service de Réanimation, CH Saint-Lô Memorial France-Etat-Unis, Saint-Lô, France.

6UCBN, U2RM, Caen, 14032, France.

7Centre d’Investigation Clinique—Innovations Technologiques, Services de Physiologie—Explorations Fonctionnelles, Hôpital Raymond Poincaré, AP-HP, EA 4497, Université de Versailles-Saint Quentin en Yvelines, Garches, France.

8INSERM, U 955, Créteil, Paris, France.

* See also p. 737.

Currently listed as ClinicalTrials.gov (NCT01518075).

Drs. Terzi, Normand, and Lofaso conceived the original protocol and then initiated and conducted the study. Dr. Normand and Ms. Dumanowski recorded the data. Dr. Terzi analyzed the data and drafted the manuscript. Drs. Ramakers, Seguin, Daubin, Valette, Masson, Sauneuf, Charbonneau, du Cheyron, and Lofaso helped to conduct the study and to draft the final manuscript. Drs. Terzi, Normand, and Lofaso participated in the coordination of the study. All authors read and approved the final manuscript.

Supported, in part, by the CHU de Caen.

Dr. Terzi received a grant from the Société de Réanimation de Langue Française—Société de Pneumologie de Langue Française. Dr. Normand received support from Boehringer Ingelheim for CME lecture. His institution received grant support from the French Space Agency and the EC. Dr. Lofaso’s university is negotiating with ResMed in order to serve as its consultant. None of the authors has any past or present financial connections with ResMed. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: terzi-n@chu-caen.fr

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins