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Breathing-swallowing interaction in neuromuscular patients: a physiological evaluation
Nicolas Terzi1, David Orlikowski, Philippe Aegerter
1Services de Réanimation Médicale, Physiologie-Explorations Fonctionnelles, and Centre d'Innovations Technologiques, Hôpital Raymond Poincaré, AP-HP, Garches, France.
Patients with neuromuscular disease have abnormal breathing-swallowing coordination. Mechanical ventilation (MV) improved swallowing in tracheostomized patients, offering a potential therapeutic strategy.
Area of Science:
- Neurology
- Pulmonology
- Gastroenterology
Background:
- Malnutrition and aspiration are significant challenges in neuromuscular disease.
- Impaired swallowing in these patients exacerbates malnutrition, necessitating improved swallowing interventions.
Purpose of the Study:
- To investigate the interplay between breathing and swallowing in individuals with neuromuscular disorders.
- To assess the effect of mechanical ventilation (MV) on swallowing function in tracheostomized patients.
Main Methods:
- Studied 10 healthy individuals and 29 patients with neuromuscular disease and chronic respiratory failure.
- Recorded 19 tracheostomized patients during spontaneous breathing (SB) and MV, in random order.
- Utilized chin electromyography and respiratory plethysmography to analyze breathing-swallowing interactions with varying bolus sizes.
Main Results:
- Neuromuscular patients exhibited piecemeal deglutition, unlike healthy individuals who swallowed whole boluses.
- Approximately 50% of swallows in patients were followed by expiration, compared to nearly 100% in controls.
- Swallowing efficiency (number of swallows, total time per bolus) correlated with maximal inspiratory pressure and improved significantly with MV in tracheostomized patients.
Conclusions:
- Abnormal breathing-swallowing interactions are present in neuromuscular disease and linked to respiratory muscle strength.
- Mechanical ventilation demonstrated a positive impact on swallowing parameters in spontaneous breathing tracheostomized patients.
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