title: Noninvasive ventilation and breathing-swallowing interplay in chronic obstructive pulmonary disease*.
abstract: OBJECTIVE
  To investigate breathing-swallowing interactions in patients with chronic obstructive pulmonary disease requiring noninvasive mechanical ventilation and, if needed, to develop a technical modification of the ventilator designed to eliminate ventilator insufflations during swallowing.
  
  
  METHODS
  We conducted a prospective, open-label, interventional study.
  
  
  METHODS
  Fifteen consecutive chronic obstructive pulmonary disease patients with exacerbations requiring ICU admission and NIV.
  
  
  METHODS
  Swallowing performance and breathing-swallowing interactions were investigated noninvasively by chin electromyography, cervical piezoelectric sensor, and inductive respiratory plethysmography. Two water-bolus sizes (5 and 10 mL) were tested in random order. Swallowing was tested with and without noninvasive mechanical ventilation, in random order. First, a standard mechanical ventilator capable of delivering noninvasive mechanical ventilation was used. Second, a marketed device was equipped with an off-switch for use during swallowing.
  
  
  RESULTS
  Swallowing performance and breathing-swallowing interactions were investigated noninvasively by chin electromyography, cervical piezoelectric sensor, and inductive respiratory plethysmography. Two water bolus sizes (5 and 10 mL) were tested in random order. Swallowing was tested with and without noninvasive mechanical ventilation in random order. First, a standard mechanical ventilator capable of delivering noninvasive mechanical ventilation was used. Swallowing efficiency, breathing-swallowing synchronization, and Borg Scale dyspnea scores improved significantly with noninvasive mechanical ventilation. However, swallowing induced ventilator triggering followed by autotriggering. To improve patient-ventilator synchrony, a marketed device was equipped with an off-switch for use during swallowing. This device completely eliminated swallowing-induced ventilator triggering and postswallow autotriggering.
  
  
  CONCLUSIONS
  Patients with chronic obstructive pulmonary disease admitted to the ICU for acute exacerbations had abnormal breathing-swallowing interactions and dyspnea, which improved with noninvasive mechanical ventilation. Furthermore, a ventilator device with a simple switch-off pushbutton to eliminate insufflations during swallows prevented swallowing-induced ventilator triggering and postswallow autotriggering.
authors.affiliation: 1Inserm, U 1075 COMETE, Caen, 14032, France. 2UCBN, COMETE, Caen, 14032, France. 3Service de Réanimation Médicale, CHRU, Caen, France. 4Service d'Explorations Fonctionnelles Respiratoire, CHRU, Caen, France. 5Service de Réanimation, CH Saint-Lô Memorial France-Etat-Unis, Saint-Lô, France. 6UCBN, U2RM, Caen, 14032, France. 7Centre d'Investigation Clinique-Innovations Technologiques, Services de Physiologie-Explorations Fonctionnelles, Hôpital Raymond Poincaré, AP-HP, EA 4497, Université de Versailles-Saint Quentin en Yvelines, Garches, France. 8INSERM, U 955, Créteil, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Terzi
authors.forename: Hervé
authors.initials: H
authors.lastname: Normand
authors.forename: Edith
authors.initials: E
authors.lastname: Dumanowski
authors.forename: Michel
authors.initials: M
authors.lastname: Ramakers
authors.forename: Amélie
authors.initials: A
authors.lastname: Seguin
authors.forename: Cédric
authors.initials: C
authors.lastname: Daubin
authors.forename: Xavier
authors.initials: X
authors.lastname: Valette
authors.forename: Romain
authors.initials: R
authors.lastname: Masson
authors.forename: Bertrand
authors.initials: B
authors.lastname: Sauneuf
authors.forename: Pierre
authors.initials: P
authors.lastname: Charbonneau
authors.forename: Damien
authors.initials: D
authors.lastname: du Cheyron
authors.forename: Frédéric
authors.initials: F
authors.lastname: Lofaso
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D003679:Deglutition / Q000502:physiology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000295:instrumentation / Q000379:methods*; D010991:Plethysmography / Q000379:methods; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000628:therapy*; D012119:Respiration; D012129:Respiratory Function Tests; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D012122:Ventilators, Mechanical