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

BackgroundRespiratory 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.MethodsTen 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.ResultsNIV 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 ConclusionThe use of patient controlled NIV improves swallowing parameters in patients with severe neuromuscular respiratory failure requiring daytime NIV, without impairing swallowing comfort.Trial RegistrationClinicalTrials.gov NCT01519388

背景：神经肌肉疾病患者出现呼吸受累时，可导致呼吸-吞咽相互作用受损、吞咽障碍及营养不良。本研究旨在探讨，在需日间无创通气（non-invasive ventilation, NIV）支持的神经肌肉疾病患者群体中，采用患者自控无创通气是否可改善其吞咽功能。方法：本研究纳入10例伴严重呼吸衰竭、需长期使用NIV的神经肌肉疾病患者，分别在未使用NIV及使用NIV（采用改良呼吸机，允许患者按需暂停通气）的状态下开展吞咽测试。通过颏肌肌电图、颈部压电传感器、鼻流量记录及感应体积描记法评估呼吸-吞咽相互作用。按随机顺序测试两种体积的水团块（5ml与10ml）以及质地型酸奶团块。结果：使用NIV可显著改善吞咽碎裂情况（定义为单次团块吞咽过程中呼吸中断的次数）（p=0.003），并提升呼吸-吞咽同步性（吞咽后紧随呼气的比例显著升高）。结论：对于需日间NIV支持的重症神经肌肉呼吸衰竭患者，采用患者自控无创通气可改善其吞咽相关参数，且不会降低吞咽舒适度。试验注册：ClinicalTrials.gov NCT01519388