Swallowing and swallowing-breathing interaction as predictors of intubation in Guillain-Barré syndrome.

Background: Bulbar weakness and respiratory impairment have been associated with increased morbidity in retrospective studies of Guillain-Barré syndrome (GBS) patients. The aim of this study was to prospectively explore the relationship between subclinical swallowing impairment, respiratory function parameters, the necessity to intubate patients and the development of early postintubation pneumonia in patients with GBS in the intensive care unit (ICU)

Methods: Respiratory, swallowing, and tongue strength parameters were measured in 30 consecutive adults (51.7 ± 18.

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

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).

Physiological comparison of breathing patterns with neurally adjusted ventilatory assist (NAVA) and pressure-support ventilation to improve NAVA settings.

Neurally adjusted ventilator assist (NAVA) assists spontaneous breathing in proportion to diaphragmatic electrical activity (EAdi). Here, we evaluate the effects of various levels of NAVA and PSV on the breathing pattern and, thereby, on [Formula: see text] homeostasis in 10 healthy volunteers. For each ventilation mode, four levels of support (delivered pressure 0 i.

An open-source software for automatic calculation of respiratory parameters based on esophageal pressure.

Purpose: We have developed a software that automatically calculates respiratory effort indices, including intrinsic end expiratory pressure (PEEPi) and esophageal pressure-time product (PTPeso).

Materials And Methods: The software first identifies respiratory periods. Clean signals are averaged to provide a reference mean cycle from which respiratory parameters are extracted.

Patient-controlled positive end-expiratory pressure with neuromuscular disease: effect on speech in patients with tracheostomy and mechanical ventilation support.

Objective: Communication is a major issue for patients with tracheostomy who are supported by mechanical ventilation. The use of positive end-expiratory pressure (PEEP) may restore speech during expiration; however, the optimal PEEP level for speech may vary individually. We aimed to improve speech quality with an individually adjusted PEEP level delivered under the patient's control to ensure optimal respiratory comfort.

Effect of a tracheostomy speaking valve on breathing-swallowing interaction.

Purpose: Expiratory flow towards the upper airway after swallowing serves to expel liquid or food particles misdirected towards the trachea during swallowing. However, expiration may not occur consistently after swallowing in tracheostomised patients with an open tracheostomy tube. We investigated the effect of a speaking valve (SV) on breathing-swallowing interactions and on the volume expelled through the upper airway after swallowing.

Impact of tracheostomy on swallowing performance in Duchenne muscular dystrophy.

Mechanical ventilation has improved survival in patients with Duchenne muscular dystrophy (DMD). Over time, these patients experience upper airway dysfunction, swallowing impairments, and dependency on the ventilator that may require invasive mechanical ventilation via a tracheostomy. Tracheostomy is traditionally believed to further impair swallowing.

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

Purpose: 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 cmH(2)O) and of a Passy-Muir speaking valve (PMV) during assist-control ventilation.

Sniff and Muller manoeuvres to measure diaphragmatic muscle strength.

We hypothesized that peak values of oesophageal (Poes) and transdiaphragmatic pressure (Pdi) swings during a maximal sniff manoeuvre and a maximal static inspiratory manoeuvre (Muller manoeuvre) are comparable or give complementary information for assessing diaphragmatic and global inspiratory muscle strength. We studied 98 patients with suspected diaphragmatic dysfunction. Poes and Pdi swings were measured during maximal sniff manoeuvres (sniff), maximal Muller manoeuvres (max), and cervical magnetic phrenic nerve stimulation (cervical Tw).

Breathing-swallowing interaction in neuromuscular patients: a physiological evaluation.

Rationale: Malnutrition and aspiration are major problems in patients with neuromuscular disease. Because impaired swallowing contributes to malnutrition, means of improving swallowing are needed.

Objectives: To investigate interactions between breathing and swallowing in neuromuscular disorders and to evaluate the impact of mechanical ventilation (MV) on swallowing in tracheostomized patients.

Oxygen consumption during machine-assisted and unassisted walking: a pilot study in hemiplegic and healthy humans.

Objective: To determine whether a gait-training (GT) machine influenced walking time duration and oxygen consumption in hemiplegic patients.

Design: Repeated measures with comparison of 2 groups.

Setting: Physiology laboratories in a rehabilitation hospital.

Assessing inspiratory muscle strength by sniff nasal inspiratory pressure.

The sniff nasal inspiratory pressure (SNIP) consists in the measurement of pressure through an occluded nostril during sniffs performed through the controlateral nostril. It is an accurate and noninvasive approximation of esophageal pressure swing during sniff maneuvers. However SNIP can underestimate esophageal pressure swing in subjects with nasal obstruction, patients with chronic obstructive pulmonary disease and severe neuromuscular patients.

Is forced oscillation technique useful in the diagnosis of occupational asthma?

Objective: The aim of the study was to determine whether the forced oscillation technique (FOT), which does not require active cooperation, may be useful to assess bronchial responsiveness in patients with suspected occupational asthma (OA).

Methods: Changes in resistances evaluated by FOT, and DeltaFEV1 measured during methacholine challenge test were compared in 77 adults referred for suspected OA. Spearman correlations and ROC curves were used.

Respiratory effects of combined truncal and abdominal support in patients with spinal cord injury.

Objective: To determine whether a custom girdle, designed to provide truncal stability and abdominal support, will improve pulmonary function, enhance inspiratory muscle activity, and reduce the sensation of respiratory effort in patients with spinal cord injury (SCI).

Design: Pulmonary function, transdiaphragmatic pressure time product (PTP di ), twitch (Tw Pdi) and maximal transdiaphragmatic pressures (Pdi), and perception of respiratory effort (Borg Rating of Perceived Exertion score) were measured with and without an abdominal girdle in a seated position.

Setting: Rehabilitation hospital.

Cough determinants in patients with neuromuscular disease.

Neuromuscular disease leads to cough impairment. Cough augmentation can be achieved by mechanical insufflation (MI) or manually assisted coughing (MAC). Many studies have compared these two methods, but few have evaluated them in combination.

Upper airway calibre and impedance in patients with Steinert's myotonic dystrophy.

Myotonic dystrophy (MD) can be responsible for increased inspiratory muscle loading, the origin of which is debated, with some authors incriminating distal lesions and others central abnormalities. Using a recent non-invasive method based on single transient pressure-wave reflection analysis, we measured central airway calibre from the mouth to the carina and respiratory impedance in a group of adults with MD, a group of patients with sleep apnoea syndrome (SAS) but no neuromuscular disease, and a group of normal controls. All participants were awake during the measurements.

Perceived inspiratory difficulty in neuromuscular patients with primary muscle disorders.

Intensity of perceived inspiratory difficulty was investigated in 17 patients with severe respiratory insufficiency due to muscle disease, compared with healthy matched controls. Subjects breathed through a threshold valve generating a constant inspiratory negative pressure proportional to their maximal inspiratory pressure. Four load levels ranging from 10 to 40% of the maximal inspiratory pressure were applied in random order.

Comparative effects of two ventilatory modes on speech in tracheostomized patients with neuromuscular disease.

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 production of assist-control ventilation (ACV) and bilevel positive-pressure ventilation (BPPV) in nine patients with neuromuscular disease.