Speech effects of a speaking valve versus external PEEP in tracheostomized ventilator-dependent neuromuscular patients.
OBJECTIVE
Many patients with respiratory failure related to neuromuscular disease receive chronic invasive ventilation through a tracheostomy. Improving quality of life, of which speech is an important component, is a major goal in these patients. We compared the effects on breathing and speech of low-level positive end-expiratory pressure (PEEP, 5 cmH(2)O) and of a Passy-Muir speaking valve (PMV) during assist-control ventilation.


METHODS
We studied ten patients with neuromuscular disorders, between December 2008 and April 2009. Flow was measured using a pneumotachograph. Microphone speech recordings were subjected to both quantitative measurements and qualitative assessments; the latter consisted of both an intelligibility score (using a French adaptation of the Frenchay Dysarthria Assessment) and a perceptual score determined by two speech therapists.


RESULTS
Text reading time, perceptive score, intelligibility score, speech comfort, and respiratory comfort were similar with PEEP and PMV. During speech with 5 cmH(2)O PEEP, six of the ten patients had no return of expiratory gas to the expiratory line and, therefore, had the entire insufflated volume available for speech, a condition met during PMV use in all patients. During speech, the respiratory rate increased by at least 3 cycles/min above the backup rate in seven patients with PEEP and in none of the patients with PMV.


CONCLUSIONS
Low-level PEEP is as effective as PMV in ensuring good speech quality, which might be explained by sealed expiratory line with low-level PEEP and/or respiratory rate increase during speech with PEEP observed in most of the patients.
Services de Physiologie, Explorations Fonctionnelles, Réanimation Médicale, Rééducation Fonctionnelle, et Centre d'Investigation Clinique et d'Innovation Technologique (Inserm Unit 805), Hôpital Raymond Poincaré, AP-HP, 92380, Garches, France. helene.prigent@rpc.ap-hop-paris.fr.
Hélène
H
Prigent
Services de Physiologie, Explorations Fonctionnelles, Réanimation Médicale, Rééducation Fonctionnelle, et Centre d'Investigation Clinique et d'Innovation Technologique (Inserm Unit 805), Hôpital Raymond Poincaré, AP-HP, 92380, Garches, France.
Marine
M
Garguilo
Services de Physiologie, Explorations Fonctionnelles, Réanimation Médicale, Rééducation Fonctionnelle, et Centre d'Investigation Clinique et d'Innovation Technologique (Inserm Unit 805), Hôpital Raymond Poincaré, AP-HP, 92380, Garches, France.
Sophie
S
Pascal
Services de Physiologie, Explorations Fonctionnelles, Réanimation Médicale, Rééducation Fonctionnelle, et Centre d'Investigation Clinique et d'Innovation Technologique (Inserm Unit 805), Hôpital Raymond Poincaré, AP-HP, 92380, Garches, France.
Samuel
S
Pouplin
Services de Physiologie, Explorations Fonctionnelles, Réanimation Médicale, Rééducation Fonctionnelle, et Centre d'Investigation Clinique et d'Innovation Technologique (Inserm Unit 805), Hôpital Raymond Poincaré, AP-HP, 92380, Garches, France.
Justine
J
Bouteille
Services de Physiologie, Explorations Fonctionnelles, Réanimation Médicale, Rééducation Fonctionnelle, et Centre d'Investigation Clinique et d'Innovation Technologique (Inserm Unit 805), Hôpital Raymond Poincaré, AP-HP, 92380, Garches, France.
Michèle
M
Lejaille
Services de Physiologie, Explorations Fonctionnelles, Réanimation Médicale, Rééducation Fonctionnelle, et Centre d'Investigation Clinique et d'Innovation Technologique (Inserm Unit 805), Hôpital Raymond Poincaré, AP-HP, 92380, Garches, France.
David
D
Orlikowski
Services de Physiologie, Explorations Fonctionnelles, Réanimation Médicale, Rééducation Fonctionnelle, et Centre d'Investigation Clinique et d'Innovation Technologique (Inserm Unit 805), Hôpital Raymond Poincaré, AP-HP, 92380, Garches, France.|Inserm U 955, Créteil, France.
Frédéric
F
Lofaso
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D009468:Neuromuscular Diseases / Q000150:complications / Q000503:physiopathology*; D011175:Positive-Pressure Respiration; D011788:Quality of Life; D012131:Respiratory Insufficiency / Q000209:etiology*; D013060:Speech; D014139:Tracheostomy / Q000295:instrumentation*