Respiratory Failure in Amyotrophic Lateral Sclerosis.

Purpose The aim of this study was to conduct a systematic review of the literature relating to the feasibility, utility, and safety of augmentative and alternative communication (AAC) interventions...

The Feasibility, Utility, and Safety of Communication Interventions With Mechanically Ventilated Intensive Care Unit Patients: A Systematic Review.

This paper reviews management strategies for patients undergoing prolonged mechanical ventilation (PMV). Topics covered include how to identify and correct barriers to weaning, the systematic approach to weaning trials, when to cease weaning trials and proceed with life-long support, managing the tracheostomy tube during PMV, and, finally, how to select a suitable mechanical ventilator for PMV.

http://rc.rcjournal.com/content/respcare/57/6/889.full.pdf

Long-Term Mechanical Ventilation: Management Strategies

Families in the Intensive Care Unit: A Guide to Understanding, Engaging, and Supporting at the Bedside

Patient-Controlled Positive End-Expiratory Pressure With Neuromuscular Disease: Effect on Speech in Patients With Tracheostomy and Mechanical Ventilation Support

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 cmH2O) and of a Passy-Muir speaking valve (PMV) during assist-control ventilation. 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. Text reading time, perceptive score, intelligibility score, speech comfort, and respiratory comfort were similar with PEEP and PMV. During speech with 5 cmH2O 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. 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.

/pdf/speech-effects-of-a-speaking-valve-versus-external-peep-in-296r68oycm.pdf

Speech effects of a speaking valve versus external PEEP in tracheostomized ventilator-dependent neuromuscular patients.

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.


Conclusion 
The use of patient controlled NIV improves swallowing parameters in patients with severe neuromuscular respiratory failure requiring daytime NIV, without impairing swallowing comfort.


Trial Registration 
ClinicalTrials.gov NCT01519388

/pdf/noninvasive-mechanical-ventilation-improves-breathing-1t8b9ja37o.pdf

Noninvasive Mechanical Ventilation Improves Breathing-Swallowing Interaction of Ventilator Dependent Neuromuscular Patients: A Prospective Crossover Study

Marine Garguilo

Papers

Speech effects of a speaking valve versus external PEEP in tracheostomized ventilator-dependent neuromuscular patients.

Patient-Controlled Positive End-Expiratory Pressure With Neuromuscular Disease: Effect on Speech in Patients With Tracheostomy and Mechanical Ventilation Support

Noninvasive Mechanical Ventilation Improves Breathing-Swallowing Interaction of Ventilator Dependent Neuromuscular Patients: A Prospective Crossover Study