title: Breathing-swallowing interaction in neuromuscular patients: a physiological evaluation.
abstract: 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.
authors.affiliation: Services de Réanimation Médicale, Physiologie-Explorations Fonctionnelles, and Centre d'Innovations Technologiques, Hôpital Raymond Poincaré, AP-HP, Garches, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Terzi
authors.forename: David
authors.initials: D
authors.lastname: Orlikowski
authors.forename: Philippe
authors.initials: P
authors.lastname: Aegerter
authors.forename: Michèle
authors.initials: M
authors.lastname: Lejaille
authors.forename: Maria
authors.initials: M
authors.lastname: Ruquet
authors.forename: Gérard
authors.initials: G
authors.lastname: Zalcman
authors.forename: Christophe
authors.initials: C
authors.lastname: Fermanian
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Raphael
authors.forename: Frédéric
authors.initials: F
authors.lastname: Lofaso
mesh_terms: 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