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 ventilator-dependent. 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.
Footnotes
- Correspondence: Brigitte Fauroux MD PhD, Pediatric Noninvasive Ventilation and Sleep Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Necker, 149 rue de Sèvres, F-75015 Paris, France. E-mail: brigitte.fauroux{at}nck.aphp.fr.
Dr Fauroux is supported by the Association Française contre les Myopathies, Vaincre la Mucoviscidose, Assistance Publique-Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale, Université Pierre et Marie Curie-Paris 6, Association d'Entraide des Polios et Handicapés Assistance, ASV Santé, IP Santé Domicile, and S2A Santé. ResMed (Saint-Priest, France) participated in the design of the questionnaire and the collection of the questionnaire data but had no role in data analysis, interpretation of the results, writing the manuscript, or the decision to submit the paper for publication. The Centre d'Innovations Technologiques received €7,000 from ResMed to pay for statistical analysis of the questionnaire results. The authors have disclosed no other conflicts of interest.
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