title: Noninvasive Mechanical Ventilation Improves Breathing-Swallowing Interaction of Ventilator Dependent Neuromuscular Patients: A Prospective Crossover Study.
abstract: BACKGROUND
  Respiratory involvement in neuromuscular disorders may contribute to impaired breathing-swallowing interactions, swallowing disorders and malnutrition. We investigated whether the use of non-invasive ventilation (NIV) controlled by the patient could improve swallowing performances in a population of neuromuscular patients requiring daytime NIV.
  
  
  METHODS
  Ten neuromuscular patients with severe respiratory failure requiring extensive NIV use were studied while swallowing without and with NIV (while ventilated with a modified ventilator allowing the patient to withhold ventilation as desired). Breathing-swallowing interactions were investigated by chin electromyography, cervical piezoelectric sensor, nasal flow recording and inductive plethysmography. Two water-bolus sizes (5 and 10ml) and a textured yogurt bolus were tested in a random order.
  
  
  RESULTS
  NIV use significantly improved swallowing fragmentation (defined as the number of respiratory interruption of the swallowing of a single bolus) (p = 0.003) and breathing-swallowing synchronization (with a significant increase of swallows followed by an expiration) (p <0.0001). Patient exhibited piecemeal swallowing which was not influenced by NIV use (p = 0.07). NIV use also significantly reduced dyspnea during swallowing (p = 0.04) while preserving swallowing comfort, regardless of bolus type.
  
  
  CONCLUSIONS
  The use of patient controlled NIV improves swallowing parameters in patients with severe neuromuscular respiratory failure requiring daytime NIV, without impairing swallowing comfort.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01519388.
authors.affiliation: UMR1179, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France.
authors.forename: Marine
authors.initials: M
authors.lastname: Garguilo
authors.affiliation: UMR1179, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France.|CIC INSERM 1429 - Raymond Poincaré Hospital, AP-HP, Garches, France.
authors.forename: Michèle
authors.initials: M
authors.lastname: Lejaille
authors.affiliation: CIC INSERM 1429 - Raymond Poincaré Hospital, AP-HP, Garches, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Vaugier
authors.affiliation: UMR1179, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France.|CIC INSERM 1429 - Raymond Poincaré Hospital, AP-HP, Garches, France.|Home ventilation unit (Intensive Care Department), Raymond Poincaré Hospital, AP-HP, Garches, France.
authors.forename: David
authors.initials: D
authors.lastname: Orlikowski
authors.affiliation: Intensive Care Department, CHRU Caen, Caen, France.|INSERM U1075 - Université de Caen, Caen, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Terzi
authors.affiliation: UMR1179, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France.|Physiology Department, Raymond Poincaré Hospital, AP-HP, Garches, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Lofaso
authors.affiliation: UMR1179, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France.|Physiology Department, Raymond Poincaré Hospital, AP-HP, Garches, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Prigent
mesh_terms: D000293:Adolescent; D000328:Adult; D018592:Cross-Over Studies; D003679:Deglutition / Q000502:physiology*; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D063087:Noninvasive Ventilation / Q000295:instrumentation / Q000379:methods*; D010358:Patient Participation; D010991:Plethysmography; D011446:Prospective Studies; D012119:Respiration; D012131:Respiratory Insufficiency / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012122:Ventilators, Mechanical