Breathing-swallowing interaction in neuromuscular patients: a physiological evaluation.
BACKGROUND
Malnutrition and aspiration are major problems in patients with neuromuscular disease. Because impaired swallowing contributes to malnutrition, means of improving swallowing are needed.


OBJECTIVE
To investigate interactions between breathing and swallowing in neuromuscular disorders and to evaluate the impact of mechanical ventilation (MV) on swallowing in tracheostomized patients.


METHODS
We studied 10 healthy individuals and 29 patients with neuromuscular disease and chronic respiratory failure (including 19 with tracheostomy). The tracheostomized patients who could breathe spontaneously were recorded during spontaneous breathing (SB) and with MV, in random order.


RESULTS
Breathing-swallowing interactions were investigated by chin electromyography and inductive respiratory plethysmography, using three water-bolus sizes (5, 10, and 15 ml) in random order. In contrast to healthy individuals, neuromuscular patients showed piecemeal deglutition with several swallows over several breathing cycles for each bolus. The percentage of swallows followed by expiration was about 50% in the patients compared with nearly 100% in the control subjects. The number of swallows and total swallowing time per bolus correlated significantly to maximal inspiratory pressure. In the 10 tracheostomized patients who were recorded both in SB and MV, the number of swallows and total swallowing time per bolus were significantly reduced during MV compared with SB.


CONCLUSIONS
Neuromuscular patients showed abnormal breathing-swallowing interactions, which correlated to maximal inspiratory pressure. Moreover, MV improved the swallowing parameters in tracheostomized patients who were able to breathe spontaneously.
Terzi
Nicolas
N
Services de Réanimation Médicale, Physiologie-Explorations Fonctionnelles, and Centre d'Innovations Technologiques, Hôpital Raymond Poincaré, AP-HP, Garches, France.
Orlikowski
David
D
Aegerter
Philippe
P
Lejaille
Michèle
M
Ruquet
Maria
M
Zalcman
Gérard
G
Fermanian
Christophe
C
Raphael
Jean-Claude
JC
Lofaso
Frédéric
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D003679:Deglutition / Q000502:physiology*; D004185:Disability Evaluation; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000503:physiopathology* / Q000628:therapy*; D010991:Plethysmography; D012119:Respiration; D012121:Respiration, Artificial; D014139:Tracheostomy; D014939:Work of Breathing