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Breathing–Swallowing Interaction in Neuromuscular Patients

A Physiological Evaluation

Services de Réanimation Médicale, Physiologie–Explorations Fonctionnelles, and Centre d'Innovations Technologiques, Hôpital Raymond Poincaré, AP-HP, Garches; Unité de Recherche Clinique de l'Hôpital Ambroise Paré, AP-HP, Boulogne; Inserm U 651, Créteil; and Service de Pneumologie, Centre Hospitalier Universitaire de Caen, Caen, France

Correspondence and requests for reprints should be addressed to Prof. F. Lofaso, M.D., Ph.D., Service de Physiologie–Explorations Fonctionnelles, Hôpital Raymond Poincaré, 92380 Garches, France. E-mail: f.lofaso{at}rpc.ap-hop-paris.fr

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.

Methods: We studied 10 healthy individuals and 29 patients with neuromuscular disease and chronic respiratory failure (including 19 with tracheostomy). The tracheostomized patients who could breathe spontaneously were recorded during spontaneous breathing (SB) and with MV, in random order.

Measurements and Main Results: Breathing–swallowing interactions were investigated by chin electromyography and inductive respiratory plethysmography, using three water-bolus sizes (5, 10, and 15 ml) in random order. In contrast to healthy individuals, neuromuscular patients showed piecemeal deglutition with several swallows over several breathing cycles for each bolus. The percentage of swallows followed by expiration was about 50% in the patients compared with nearly 100% in the control subjects. The number of swallows and total swallowing time per bolus correlated significantly to maximal inspiratory pressure. In the 10 tracheostomized patients who were recorded both in SB and MV, the number of swallows and total swallowing time per bolus were significantly reduced during MV compared with SB.

Conclusion: Neuromuscular patients showed abnormal breathing–swallowing interactions, which correlated to maximal inspiratory pressure. Moreover, MV improved the swallowing parameters in tracheostomized patients who were able to breathe spontaneously.

Key Words: neuromuscular disorder • swallowing • mechanical ventilation • control of breathing • tracheostomy

AT A GLANCE COMMENTARY Scientific Knowledge of the Subject Malnutrition is common in patients with neuromuscular disease. Impaired swallowing jeopardizes the patient's ability to meet intake needs. What This Study Adds to the Field In neuromuscular patients, deglutition is fragmented in several swallows over several breathing cycles. Swallowing parameters are better in tracheostomized patients when they are under mechanical ventilation than in spontaneous breathing.

 

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