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.
Prigent
Hélène
H
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.
Garguilo
Marine
M
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.
Pascal
Sophie
S
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.
Pouplin
Samuel
S
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.
Bouteille
Justine
J
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.
Lejaille
Michèle
M
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.
Orlikowski
David
D
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.
Lofaso
Frédéric
F
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.
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*