How to eat, drink and speak on non-invasive ventilation

Abstract

We report our observations on six individuals with non-bulbar neuromuscular disorders using non-invasive ventilation (NIV), who were able to maintain adequate hydration and nutrition orally despite being ventilator-dependant. All had severe respiratory muscle weakness, with a vital capacity less than 500 mL and cough peak flow rate less than 250 L/min. Their median (range) age was 49 (23–64) years; they had been on NIV for 8 (2–24) years. We compared them with an age- and sex-matched normal control. Individuals with neuromuscular disorders needed to chew each mouthful of food significantly more times (median 44, range 18–120 chews) than normal controls (median 15, range 10–20 chews). They took longer to completely swallow a mouthful of food (median 37, range 24–100 s) compared to normal controls (median 14.5, range 10–21 s). Multiple swallows for each mouthful were seen in all neuromuscular individuals, but in only one normal control. Two individuals coughed after swallowing; both these subjects were clinically stable at the time of the study. The median number of NIV breaths associated with chest expansion for each mouthful was 11 (range 5–49). All subjects blocked some NIV breaths whilst eating. Before swallowing, they always waited until the expiratory phase of the NIV breath was complete; no post-swallow expiration was seen, whereas normal subjects invariably exhibited post-swallow expiration. All individuals were able to block several ventilator breaths whilst swallowing un-thickened liquids. The median (range) number of words between breaths was 5 (4–7) for the neuromuscular individuals on NIV, significantly fewer than 11 (8–13) for the matched controls. Eating, drinking and speaking are possible whilst on NIV. Use of cough-assist after eating is recommended, given the likelihood of silent aspiration.

Impacto de la cánula nasal de alto flujo y la ventilación no invasiva en la fisiología deglutoria: revisión de la literatura

“…Por otra parte, sujetos con enfermedades respiratorias crónicas (principalmente EPOC), frecuentemente requieren uso de estos dispositivos ventilatorios y además presentan alteraciones en el proceso deglutorio (Ghannouchi et al, 2016;Terada et al, 2010), lo que podría incrementar su riesgo aspirativo. En particular, en el caso de las personas con enfermedades neuromusculares, muchas veces el uso de dispositivos de ventilación no invasiva son utilizados de forma permanente debido a la condición fisiopatológica subyacente, existiendo reportes sobre el proceso de alimentación (Britton et al, 2020;Garguilo et al, 2016;Kinnear et al, 2021). Incluso uno de ellos postula que el uso de la VNI mejoraría la coordinación respiración-deglución en personas con patologías neuromusculares y dependientes crónicos de soporte ventilatorio (Garguilo et al, 2016).…”

CRD Editor’s corner archive: October-December

“…Ventilator dependence in neuromuscular diseasemanaging life's basics … December 21st, 2021 When people with neuromuscular disease become more dependent on round the clock noninvasive ventilation (NIV), the simple basics of life such as eating, drinking and talking become a significant challenge. In the journal this month, Kinnear and colleagues 1 , observe how people manage these functions whilst using NIV. Importantly, they manage to do this safely for example by timing swallowing between ventilator breaths.…”