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Published ahead of print on October 4, 2002, doi:10.1164/rccm.200201-026OC

Am. J. Respir. Crit. Care Med., Volume 167, Number 2, January 2003, 114-119

A more recent version of this article appeared on January 15, 2003
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Submitted on January 15, 2002
Accepted on September 30, 2002

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

Helene Prigent1, Christiane Samuel1, Bruno Louis2, Marie-France Abinum1, Michele Lejaille1, Jean-Claude Raphael1, and Frederic Lofaso3*

1 Services de Reanimation Medicale, Physiologie - Explorations Fonctionnelles, Reeducation Fonctionnelle, Pediatrie et Centre d'Innovations Technologiques, Hopital Raymond Poincare, Assistance Publique-Hopitaux de Paris, Garches, France, 2 INSERM U 492, Creteil, France, 3 Services de Reanimation Medicale, Physiologie - Explorations Fonctionnelles, Reeducation Fonctionnelle, Pediatrie et Centre d'Innovations Technologiques, Hopital Raymond Poincare, Assistance Publique-Hopitaux de Paris, Garches, France; INSERM U 492, Creteil, France

* To whom correspondence should be addressed. 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 and bilevel positive-pressure ventilation 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 CO2 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 bilevel positive-pressure ventilation , with a greater increase in the volume released by the ventilator during speech as compared to assist-control ventilation (172[plusmn]194 ml vs. 26[plusmn]31 ml). Consequently, speech duration was longer during inspiration with bilevel positive-pressure ventilation. Moreover, bilevel positive-pressure ventilation allowed speech production to extend into expiration, and three patients could speak continuously during several respiratory cycles while receiving bilevel positive-pressure ventilation. Blood gas exchange was not modified by speech with bilevel positive-pressure ventilation or assist-control ventilation. This study shows that BPPV provides better speech duration than assist-control ventilation, with no detectable short-term deleterious effects.
Key words: invasive mechanical ventilation, pressure support, positive end-expiratory pressure, home ventilation, comfort, neuromuscular disorder, speech




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