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Published ahead of print on October 4, 2002, doi:10.1164/rccm.200201-026OC
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American Journal of Respiratory and Critical Care Medicine Vol 167. pp. 114-119, (2003)
© 2003 American Thoracic Society

Original Article

Comparative Effects of Two Ventilatory Modes on Speech in Tracheostomized Patients with Neuromuscular Disease

Hélène Prigent, Christiane Samuel, Bruno Louis, Marie-France Abinun, Françoise Zerah-Lancner, Michèle Lejaille, Jean-Claude Raphael and Frédéric Lofaso

Services de Réanimation Médicale, Physiologie—Explorations Fonctionnelles, Rééducation Fonctionnelle, Pédiatrie et Centre d'Innovation Technologique, Hôpital Raymond Poincaré, Garches; and Inserm U 492, Créteil, France

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

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. Ventilator-delivered flow was measured using a pneumotachograph, and respiratory rate, inspiratory time, and ventilator-delivered volume were measured on this flow signal. Gas exchange was assessed using oxygen saturation and end-tidal carbon dioxide measurement. Microphone speech recordings were subjected to quantitative analysis. At rest, ventilatory parameters were similar with both modes. Speech induced an increase in inspiratory time during BPPV, with a greater increase in the volume released by the ventilator during speech as compared with ACV (172 ± 194 versus 26 ± 31 ml). Consequently, speech duration was longer during inspiration with BPPV. Moreover, BPPV allowed speech production to extend into expiration, and three patients could speak continuously during several respiratory cycles while receiving BPPV. Blood gas exchange was not modified by speech with BPPV or ACV. This study shows that BPPV provides better speech duration than ACV with no detectable short-term deleterious effects.

Key Words: invasive mechanical ventilation • pressure support • positive end-expiratory pressure • neuromuscular disorder • speech




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