Download PDF
Semin Speech Lang 2016; 37(03): 173-184
DOI: 10.1055/s-0036-1583545
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Beyond Tracheostomy: Noninvasive Ventilation and Potential Positive Implications for Speaking and Swallowing

Deanna Britton
1   Department of Speech & Hearing Sciences, Portland State University, Northwest Center for Voice & Swallowing
2   Department of Otolaryngology, Head & Neck Surgery, Oregon Health & Sciences University, Portland, Oregon
,
Joshua O. Benditt
3   Division of Pulmonary and Critical Care Medicine, University of Washington Medical Center, Seattle, Washington
,
Jeannette D. Hoit
4   Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, Arizona
› Author Affiliations
Further Information

Publication History

Publication Date:
27 May 2016 (online)

    Permissions and Reprints

Abstract

For more than a decade, there has been a trend toward increased use of noninvasive positive pressure ventilation (NPPV) via mask or mouthpiece as a means to provide ventilatory support without the need for tracheostomy. All indications are that use of NPPV will continue to increase over the next decade and beyond. In this article, we review NPPV, describe two common forms of NPPV, and discuss the potential benefits and challenges of NPPV for speaking and swallowing based on the available literature, our collective clinical experience, and interviews with NPPV users. We also speculate on how future research may inform clinical practice on how to best maximize speaking and swallowing abilities in NPPV users over the next decade.

Keywords

Noninvasive positive pressure ventilation (NPPV) - bilevel positive airway pressure (BPAP) - speech - dysphagia
 

  • References

  • 1 Mehta AB, Syeda SN, Bajpayee L, Cooke CR, Walkey AJ, Wiener RS. Trends in tracheostomy for mechanically ventilated patients in the United States, 1993–2012. Am J Respir Crit Care Med 2015; 192 (4) 446-454
    CrossrefPubMedGoogle Scholar
  • 2 Aboussouan LS, Ricaurte B. Noninvasive positive pressure ventilation: increasing use in acute care. Cleve Clin J Med 2010; 77 (5) 307-316
    CrossrefPubMedGoogle Scholar
  • 3 Hill NS. Use of negative pressure ventilation, rocking beds, and pneumobelts. Respir Care 1994; 39 (5) 532-545 , discussion 545–549
    PubMedGoogle Scholar
  • 4 Affeldt JE. Round Table Conference on Poliomyelitis Equipment. May 28–29 1953. White Plains, NY
    PubMedGoogle Scholar
  • 5 Pierson DJ. History and epidemiology of noninvasive ventilation in the acute-care setting. Respir Care 2009; 54 (1) 40-52
    PubMedGoogle Scholar
  • 6 Delaubier A, Guillou C, Mordelet M, Rideau Y. [Early respiratory assistance by nasal route in Duchenne's muscular dystrophy]. Agressologie 1987; 28 (7) 737-738
    PubMedGoogle Scholar
  • 7 Kacmarek RM. The mechanical ventilator: past, present, and future. Respir Care 2011; 56 (8) 1170-1180
    CrossrefPubMedGoogle Scholar
  • 8 Kelly CR, Higgins AR, Chandra S. Videos in clinical medicine. Noninvasive positive-pressure ventilation. N Engl J Med 2015; 372 (23) e30
    CrossrefPubMedGoogle Scholar
  • 9 Theerakittikul T, Ricaurte B, Aboussouan LS. Noninvasive positive pressure ventilation for stable outpatients: CPAP and beyond. Cleve Clin J Med 2010; 77 (10) 705-714
    CrossrefPubMedGoogle Scholar
  • 10 Carron M, Freo U, BaHammam AS , et al. Complications of non-invasive ventilation techniques: a comprehensive qualitative review of randomized trials. Br J Anaesth 2013; 110 (6) 896-914
    CrossrefPubMedGoogle Scholar
  • 11 Lightowler JV, Wedzicha JA, Elliott MW, Ram FS. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ 2003; 326 (7382) 185
    CrossrefPubMedGoogle Scholar
  • 12 Bach JR. Amyotrophic lateral sclerosis: prolongation of life by noninvasive respiratory aids. Chest 2002; 122 (1) 92-98
    CrossrefPubMedGoogle Scholar
  • 13 Miller RG, Jackson CE, Kasarskis EJ , et al; Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: drug, nutritional, and respiratory therapies (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2009; 73 (15) 1218-1226
    CrossrefPubMedGoogle Scholar
  • 14 Toussaint M, Steens M, Wasteels G, Soudon P. Diurnal ventilation via mouthpiece: survival in end-stage Duchenne patients. Eur Respir J 2006; 28 (3) 549-555
    CrossrefPubMedGoogle Scholar
  • 15 Soudon P, Steens M, Toussaint M. A comparison of invasive versus noninvasive full-time mechanical ventilation in Duchenne muscular dystrophy. Chron Respir Dis 2008; 5 (2) 87-93
    CrossrefPubMedGoogle Scholar
  • 16 Bach JR, Martinez D. Duchenne muscular dystrophy: continuous noninvasive ventilatory support prolongs survival. Respir Care 2011; 56 (6) 744-750
    CrossrefPubMedGoogle Scholar
  • 17 Bach JR. Management of post-polio respiratory sequelae. Ann N Y Acad Sci 1995; 753: 96-102
    CrossrefPubMedGoogle Scholar
  • 18 Hoit JD, Banzett RB. Simple adjustments can improve ventilator-supported speech. Am J Speech Lang Pathol 1997; 6 (1) 87-96
    CrossrefPubMedGoogle Scholar
  • 19 Hoit JD, Banzett RB, Lohmeier HL, Hixon TJ, Brown R. Clinical ventilator adjustments that improve speech. Chest 2003; 124 (4) 1512-1521
    CrossrefPubMedGoogle Scholar
  • 20 Dikeman K, Kazandjian M. Communication and Swallowing Management of Tracheostomized and Ventilator-Dependent Adults. 2nd ed. Clifton Park, NY: Thomson Delmar Learning Singular; 2003
    Google Scholar
  • 21 Britton D, Jones-Redmond J, Kasper C. The use of speaking valves with ventilator-dependent and tracheostomy patients. Curr Opin Otolaryngol Head Neck Surg 2001; 9: 147-152
    CrossrefPubMedGoogle Scholar
  • 22 Garguilo M, Leroux K, Lejaille M , et al. Patient-controlled positive end-expiratory pressure with neuromuscular disease: effect on speech in patients with tracheostomy and mechanical ventilation support. Chest 2013; 143 (5) 1243-1251
    CrossrefPubMedGoogle Scholar
  • 23 Hess DR. Facilitating speech in the patient with a tracheostomy. Respir Care 2005; 50 (4) 519-525
    PubMedGoogle Scholar
  • 24 Adam SI, Srinet P, Aronberg RM, Rosenberg G, Leder SB. Verbal communication with the Blom low profile and Passy-Muir one-way tracheotomy tube speaking valves. J Commun Disord 2015; 56: 40-46
    CrossrefPubMedGoogle Scholar
  • 25 Leder SB, Pauloski BR, Rademaker AW , et al. Verbal communication for the ventilator-dependent patient requiring an inflated tracheotomy tube cuff: a prospective, multicenter study on the Blom tracheotomy tube with speech inner cannula. Head Neck 2013; 35 (4) 505-510
    CrossrefPubMedGoogle Scholar
  • 26 Leder SB. Verbal communication for the ventilator-dependent patient: voice intensity with the Portex “Talk” tracheostomy tube. Laryngoscope 1990; 100 (10 Pt 1): 1116-1121
    CrossrefPubMedGoogle Scholar
  • 27 Leder SB. Importance of verbal communication for the ventilator-dependent patient. Chest 1990; 98 (4) 792-793
    CrossrefPubMedGoogle Scholar
  • 28 Leder SB. Prognostic indicators for successful use of “talking” tracheostomy tubes. Percept Mot Skills 1991; 73 (2) 441-442
    PubMedGoogle Scholar
  • 29 Nomori H. Tracheostomy tube enabling speech during mechanical ventilation. Chest 2004; 125 (3) 1046-1051
    CrossrefPubMedGoogle Scholar
  • 30 Prigent H, Garguilo M, Pascal S , et al. Speech effects of a speaking valve versus external PEEP in tracheostomized ventilator-dependent neuromuscular patients. Intensive Care Med 2010; 36 (10) 1681-1687
    CrossrefPubMedGoogle Scholar
  • 31 Prigent H, Samuel C, Louis B , et al. Comparative effects of two ventilatory modes on speech in tracheostomized patients with neuromuscular disease. Am J Respir Crit Care Med 2003; 167 (2) 114-119
    CrossrefPubMedGoogle Scholar
  • 32 Terzi N, Normand H, Dumanowski E , et al. Noninvasive ventilation and breathing-swallowing interplay in chronic obstructive pulmonary disease*. Crit Care Med 2014; 42 (3) 565-573
    CrossrefPubMedGoogle Scholar
  • 33 Hixon TJ, Hoit JD. Evaluation and Management of Speech Breathing Disorders: Principles and Methods. San Diego, CA: Plural Publishing; 2005
    Google Scholar
  • 34 Banzett RB, Lansing RW, Brown R , et al. “Air hunger” from increased PCO2 persists after complete neuromuscular block in humans. Respir Physiol 1990; 81 (1) 1-17
    CrossrefPubMedGoogle Scholar
  • 35 Banzett RB, Lansing RW, Reid MB, Adams L, Brown R. “Air hunger” arising from increased PCO2 in mechanically ventilated quadriplegics. Respir Physiol 1989; 76 (1) 53-67
    CrossrefPubMedGoogle Scholar
  • 36 Lansing RW, Im BS, Thwing JI, Legedza AT, Banzett RB. The perception of respiratory work and effort can be independent of the perception of air hunger. Am J Respir Crit Care Med 2000; 162 (5) 1690-1696
    CrossrefPubMedGoogle Scholar
  • 37 Parshall MB, Schwartzstein RM, Adams L , et al; American Thoracic Society Committee on Dyspnea. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med 2012; 185 (4) 435-452
    CrossrefPubMedGoogle Scholar
  • 38 Chonan T, Mulholland MB, Altose MD, Cherniack NS. Effects of changes in level and pattern of breathing on the sensation of dyspnea. J Appl Physiol (1985) 1990; 69 (4) 1290-1295
    PubMedGoogle Scholar
  • 39 Gandevia SC, Killian KJ, Campbell EJ. The effect of respiratory muscle fatigue on respiratory sensations. Clin Sci (Lond) 1981; 60 (4) 463-466
    CrossrefPubMedGoogle Scholar
  • 40 Killian KJ, Gandevia SC, Summers E, Campbell EJ. Effect of increased lung volume on perception of breathlessness, effort, and tension. J Appl Physiol 1984; 57 (3) 686-691
    PubMedGoogle Scholar
  • 41 Moosavi SH, Topulos GP, Hafer A , et al. Acute partial paralysis alters perceptions of air hunger, work and effort at constant P(CO(2)) and V(E). Respir Physiol 2000; 122 (1) 45-60
    CrossrefPubMedGoogle Scholar
  • 42 Huber JE, Darling M. Effect of Parkinson's disease on the production of structured and unstructured speaking tasks: respiratory physiologic and linguistic considerations. J Speech Lang Hear Res 2011; 54 (1) 33-46
    CrossrefPubMedGoogle Scholar
  • 43 Bailey EF, Hoit JD. Speaking and breathing in high respiratory drive. J Speech Lang Hear Res 2002; 45 (1) 89-99
    CrossrefPubMedGoogle Scholar
  • 44 Gross RD. Subglottic air pressure and swallowing. Perspectives on Swallowing and Swallowing Disorders (Dysphagia) 2009; 18: 13-18
    PubMedGoogle Scholar
  • 45 Terzi N, Orlikowski D, Aegerter P , et al. Breathing-swallowing interaction in neuromuscular patients: a physiological evaluation. Am J Respir Crit Care Med 2007; 175 (3) 269-276
    CrossrefPubMedGoogle Scholar
  • 46 Happel KI, Bagby GJ, Nelson S. Host defense and bacterial pneumonia. Semin Respir Crit Care Med 2004; 25 (1) 43-52
    Article in Thieme ConnectPubMedGoogle Scholar
  • 47 Bach JR. Mechanical insufflation-exsufflation: Comparison of peak expiratory flows with manually assisted and unassisted coughing techniques. Chest 1993; 104: 1553-1562
    CrossrefPubMedGoogle Scholar
  • 48 Finsterer J. Cardiopulmonary support in Duchenne muscular dystrophy. Lung 2006; 184 (4) 205-215
    CrossrefPubMedGoogle Scholar
  • 49 Mellies U, Dohna-Schwake C, Voit T. Respiratory function assessment and intervention in neuromuscular disorders. Curr Opin Neurol 2005; 18 (5) 543-547
    CrossrefPubMedGoogle Scholar
  • 50 Bourke SC, Bullock RE, Williams TL, Shaw PJ, Gibson GJ. Noninvasive ventilation in ALS: indications and effect on quality of life. Neurology 2003; 61 (2) 171-177
    CrossrefPubMedGoogle Scholar
  • 51 Vandenberghe N, Vallet AE, Petitjean T , et al. Absence of airway secretion accumulation predicts tolerance of noninvasive ventilation in subjects with amyotrophic lateral sclerosis. Respir Care 2013; 58 (9) 1424-1432
    CrossrefPubMedGoogle Scholar