Evaluation of Ventilators for Mouthpiece Ventilation in Neuromuscular Disease

Abstract

BACKGROUND: Daytime mouthpiece ventilation is a useful adjunct to nocturnal noninvasive ventilation (NIV) in patients with neuromuscular disease. The aims of the study were to analyze the practice of mouthpiece ventilation and to evaluate the performance of ventilators for mouthpiece ventilation. METHODS: Practice of mouthpiece ventilation was assessed by a questionnaire, and the performance of 6 home ventilators with mouthpiece ventilation was assessed in a bench test using 24 different conditions per ventilator: 3 mouthpieces, a child and an adult patient profile, and 4 ventilatory modes. RESULTS: Questionnaires were obtained from 30 subjects (mean age 33 ؎ 11 y) using NIV for 12 ؎ 7 y. Fifteen subjects used NIV for > 20 h/day, and 11 were totally ventilatordependent. The subject-reported benefits of mouthpiece ventilation were a reduction in dyspnea (73%) and fatigue (93%) and an improvement in speech (43%) and eating (27%). The bench study showed that none of the ventilators, even those with mouthpiece ventilation software, were able to deliver mouthpiece ventilation without alarms and/or autotriggering in each condition. Alarms and/or ineffective triggering or autotriggering were observed in 135 of the 198 conditions. The occurrence of alarms was more common with a large mouthpiece without a filter compared to a small mouthpiece with a filter (P < .001), but it was not related to the patient profile, the ventilatory mode, or the type of ventilator. CONCLUSIONS: Subjects are satisfied with mouthpiece ventilation. Alarms are common with home ventilators, although less common in those with mouthpiece ventilation software. Improvements in home ventilators are needed to facilitate the expansion of mouthpiece ventilation.

Mouthpiece Ventilation: Just a Home-Care Support?

“…In fact, the correct setting is required to avoid frequent alarms. 28 Some limitations must be considered in the study by Nicolini et al 22 First, it is a very short-term study. As a matter of fact, it would be of great interest to confirm these results with a longer follow-up.…”

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

“…The test ventilator was connected via a standard circuit and a 15-mm angled, rigid plastic mouthpiece (Philips Respironics) with a heat-and-moisture exchange filter (Hygroflux 1; Vygon, Ecouen, France; Figure 1), which showed the best results in the recently published bench evaluation, 11 to the main chamber of a twochamber test lung (Michigan Dual Adult Test Lung TTL 2600i; Michigan Instruments, Grand Rapids, Michigan, USA). The compliance of the lung model was set at 30 mL cm À1 H 2 O, and the airway resistance at 5 cm H 2 O/L s À1 (Pneuflo airway resistor Rp5; Michigan Instruments), corresponding to typical values for a neuromuscular disease adult.…”

“…The compliance of the lung model was set at 30 mL cm À1 H 2 O, and the airway resistance at 5 cm H 2 O/L s À1 (Pneuflo airway resistor Rp5; Michigan Instruments), corresponding to typical values for a neuromuscular disease adult. 11 A master ventilator (BREAS VIVO 50) was connected to the second chamber of the test lung (driving chamber), which was connected to the main chamber by a small metal component, allowing the driving chamber to lift the main chamber, mimicking the patient's contribution to inspiration. Because the metal component was not secured to the main chamber, the latter could expand freely above the driving chamber as dictated by the tested ventilator.…”

“…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. 6,11,12 Unlike bellow ventilators which deliver a constant tidal volume (V T ) for each respiratory cycle, independently of the respiratory system load, the turbine-based ventilators perform a volume-targeted pressure ventilation, using the measured V T of the previous respiratory cycles to adapt the work pressure of the delivered cycle, in order to reach the target V T . 13 This modality has been proved to be reliable in situations of constant ventilator load, 14,15 but its efficacy may be affected by changes in the characteristics of the respiratory system and by the presence of leaks.…”

Daytime Mouthpiece Ventilation Plus Nighttime Noninvasive Ventilation Improves Quality of Life in Patients With Neuromuscular Disease

“…8,9 Noninvasive ventilation improves daytime hypoventilation in patients with neuromuscular diseases, probably by improving nocturnal hypercapnia and thus restoring central chemoreceptor sensitivity. 10,11 In this issue of RESPIRATORY CARE, Khirani et al 12 report their study of ventilators for mouthpiece ventilation in patients with neuromuscular disease. For 30 subjects (mean age 33 Ϯ 11 y) with various neuromuscular diseases, the authors used a questionnaire to assess the practice and effects of mouthpiece ventilation.…”