Evaluation of ventilators for mouthpiece ventilation in neuromuscular disease.
BACKGROUND
Daytime mouthpiece ventilation is a useful adjunct to nocturnal noninvasive ventilation (NIV) in patients with neuromuscular disease. The aims of the study were to analyze the practice of mouthpiece ventilation and to evaluate the performance of ventilators for mouthpiece ventilation.


METHODS
Practice of mouthpiece ventilation was assessed by a questionnaire, and the performance of 6 home ventilators with mouthpiece ventilation was assessed in a bench test using 24 different conditions per ventilator: 3 mouthpieces, a child and an adult patient profile, and 4 ventilatory modes.


RESULTS
Questionnaires were obtained from 30 subjects (mean age 33 ± 11 y) using NIV for 12 ± 7 y. Fifteen subjects used NIV for > 20 h/day, and 11 were totally ventilator-dependent. The subject-reported benefits of mouthpiece ventilation were a reduction in dyspnea (73%) and fatigue (93%) and an improvement in speech (43%) and eating (27%). The bench study showed that none of the ventilators, even those with mouthpiece ventilation software, were able to deliver mouthpiece ventilation without alarms and/or autotriggering in each condition. Alarms and/or ineffective triggering or autotriggering were observed in 135 of the 198 conditions. The occurrence of alarms was more common with a large mouthpiece without a filter compared to a small mouthpiece with a filter (P < .001), but it was not related to the patient profile, the ventilatory mode, or the type of ventilator.


CONCLUSIONS
Subjects are satisfied with mouthpiece ventilation. Alarms are common with home ventilators, although less common in those with mouthpiece ventilation software. Improvements in home ventilators are needed to facilitate the expansion of mouthpiece ventilation.
Pediatric Pulmonary Department, Assistance Publique-Hôpitaux de Paris, Hôpital Armand Trousseau, Paris, France. S2A Santé, Ivry sur Seine, France.
Sonia
S
Khirani
Pediatric Pulmonary Department, Assistance Publique-Hôpitaux de Paris, Hôpital Armand Trousseau, Paris, France. Association d'Entraide des Polios et Handicapés Assistance, Suresnes, France.
Adriana
A
Ramirez
ASV Santé, Gennevilliers, France.
Vincent
V
Delord
Association d'Entraide des Polios et Handicapés Assistance, Suresnes, France.
Karl
K
Leroux
Physiologie-Explorations Fonctionnelles, Services de Réanimation Médicale, and the Centre d'Innovations Technologiques Unité Mixte de Recherche 805, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France, and EA 4497, Université de Versailles, Saint-Quentin-en-Yvelines, France. Institut National de la Santé et de la Recherche Médicale U955, Université Paris Est, Faculté de Médecine, Centre National de la Recherche Scientifique ERL 7240, Créteil, France.
Frédéric
F
Lofaso
IBIOM, Ingénierie pour le Biomédical, Faculté des Sciences et Techniques, Université de Rouen, Saint-Étienne du Rouvray, France.
Solène
S
Hautot
Neuromuscular Excellence Center, VUB-Inkendaal, and the Center for Home Mechanical Ventilation, Z.H. Inkendaal Rehabilitation Hospital, Brussels, Belgium.
Michel
M
Toussaint
Service de Réanimation Médicale, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France, and the Université de Versailles, Saint-Quentin-en-Yvelines, France.
David
D
Orlikowski
Institut National de la Santé et de la Recherche Médicale U955, Université Paris Est, Faculté de Médecine, Centre National de la Recherche Scientifique ERL 7240, Créteil, France.
Bruno
B
Louis
Pediatric Pulmonary Department, Assistance Publique-Hôpitaux de Paris, Hôpital Armand Trousseau, Paris, France. Institut National de la Santé et de la Recherche Médicale U955, Université Paris Est, Faculté de Médecine, Centre National de la Recherche Scientifique ERL 7240, Créteil, France. Université Pierre et Marie Curie-Paris 6, Paris, France. brigitte.fauroux@nck.aphp.fr.
Brigitte
B
Fauroux
D000293:Adolescent; D000328:Adult; D056902:Clinical Alarms; D004417:Dyspnea / Q000209:etiology / Q000517:prevention & control; D004435:Eating; D005221:Fatigue / Q000209:etiology / Q000517:prevention & control; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000150:complications / Q000628:therapy*; D063087:Noninvasive Ventilation / Q000295:instrumentation* / Q000379:methods; D017060:Patient Satisfaction; D012648:Self Care / Q000295:instrumentation; D013060:Speech; D011795:Surveys and Questionnaires; D013997:Time Factors; D012122:Ventilators, Mechanical; D055815:Young Adult
bench; daytime mouthpiece ventilation; home ventilators; neuromuscular disease; questionnaire