Open circuit mouthpiece ventilation: Concise clinical review

Mouthpiece ventilation and complementary techniques in patients with neuromuscular disease: A brief clinical review and update

“…27 With the MPV, any mode of ventilation including the pressure assisted, pressure support or bilevel positive airway, ventilation mode can be used with several ventilator circuits (double-limb or single-limb circuit with expiratory valve up to single limb with an intentional leak). 40,41 However, the latter does not permit air stacking. The volume-cycled ventilation with single-limb circuit appears the most suitable in allowing patient to air stack.…”

“…This ventilatory mode has been tested with good results in selected patients and is commonly known as ''kiss trigger.'' 40,41 Advantages, disadvantages, and side effects of ventilation with mouthpiece…”

“…15,49 The low pressure alarm will need to be set to minimum or where possible turned off altogether and the apnea alarm. 15,41,49 In newer ventilators, it is possible to set a positive expiratory pressure (expiratory positive airway pressure (EPAP) or positive end expiratory pressure (PEEP)) to 0 cmH 2 O. In other home volumetric ventilators, the minimum pressure alarm cannot be excluded; therefore, it is necessary to set up a PEEP (often 2 cmH 2 O) which, due to the resistance to the airflow created from the angle of the mouthpiece, assures a pressure that prevents the continuous activation of the alarms.…”

“…In other home volumetric ventilators, the minimum pressure alarm cannot be excluded; therefore, it is necessary to set up a PEEP (often 2 cmH 2 O) which, due to the resistance to the airflow created from the angle of the mouthpiece, assures a pressure that prevents the continuous activation of the alarms. 40,41 The patient activates the breath by putting the mouth on the mouthpiece and creating a small negative pressure in the circuit by sipping or inhaling from the mouthpiece. The negative pressure generated by a sip is much higher than that generated by a maximum static inspiratory pressure and can explain why a patient with advanced NMD can activate trigger without any inspiratory effort after a sip maneuver.…”

Accuracy of tidal volume delivered by home mechanical ventilation during mouthpiece ventilation

“…[1][2][3][4] In the current clinical practice, HMV is initially applied using a non-invasive interface during night-time, but in the course of the disease, as respiratory muscle weakness progresses, the extension of HMV during daytime may become necessary. 3,[5][6][7] Mouthpiece ventilation (MPV) can be used as an alternative to nasal or naso-buccal HMV interfaces for the daytime ventilation, and it has been reported to improve cough, speech, dyspnoea, survival and patient quality of life. 6,[8][9][10] MPV has been developed using volumetric ventilators, and a volumetric ventilation mode is usually chosen also with the new turbine-based home ventilators.…”