Journal ArticleDOI
Speech effects of a speaking valve versus external PEEP in tracheostomized ventilator-dependent neuromuscular patients.
H. Prigent,Marine Garguilo,Sophie Pascal,Samuel Pouplin,Justine Bouteille,M. Lejaille,David Orlikowski,Frédéric Lofaso +7 more
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TLDR
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.Abstract:
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.read more
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Journal ArticleDOI
The Feasibility, Utility, and Safety of Communication Interventions With Mechanically Ventilated Intensive Care Unit Patients: A Systematic Review.
TL;DR: There is developing evidence that communication interventions with mechanically ventilated ICU patients are feasible, have utility, and are safe.
Journal ArticleDOI
Long-Term Mechanical Ventilation: Management Strategies
TL;DR: This paper reviews management strategies for patients undergoing prolonged mechanical ventilation and discusses how to identify and correct barriers to weaning, the systematic approach to weaned trials, when to cease weaning trials and proceed with life-long support, managing the tracheostomy tube during PMV.
Journal ArticleDOI
Patient-Controlled Positive End-Expiratory Pressure With Neuromuscular Disease: Effect on Speech in Patients With Tracheostomy and Mechanical Ventilation Support
Marine Garguilo,Karl Leroux,Michèle Lejaille,Sophie Pascal,David Orlikowski,Frédéric Lofaso,Hélène Prigent +6 more
TL;DR: Patient-controlled PEEP allowed for the use of high levels of PEEP with good respiratory tolerance and significant improvement in speech (enabling phonation during the entire respiratory cycle in most patients), and could be implemented in home ventilators to improve speech and, therefore, autonomy of patients with tracheostomy.
Journal ArticleDOI
Year in review in Intensive Care Medicine 2010 : III. ARDS and ALI, mechanical ventilation, noninvasive ventilation, weaning, endotracheal intubation, lung ultrasound and paediatrics
Massimo Antonelli,Elie Azoulay,Marc J.M. Bonten,Jean Chastre,Giuseppe Citerio,Giorgio Conti,Daniel De Backer,Herwig Gerlach,Göran Hedenstierna,Michael Joannidis,Duncan MacRae,Jordi Mancebo,Salvatore Maurizio Maggiore,Alexandre Mebazaa,Jean-Charles Preiser,Jérôme Pugin,Jan Wernerman,Haibo Zhang +17 more
TL;DR: Year in review in Intensive Care Medicine 2010 : III.
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