• Nicolas Terzi, Hervé Normand, Edith Dumanowski, Michel Ramakers, Amélie Seguin, Cédric Daubin, Xavier Valette, Romain Masson, Bertrand Sauneuf, Pierre Charbonneau, Damien du Cheyron, and Frédéric Lofaso.
• 1Inserm, U 1075 COMETE, Caen, 14032, France. 2UCBN, COMETE, Caen, 14032, France. 3Service de Réanimation Médicale, CHRU, Caen, France. 4Service d'Explorations Fonctionnelles Respiratoire, CHRU, Caen, France. 5Service de Réanimation, CH Saint-Lô Memorial France-Etat-Unis, Saint-Lô, France. 6UCBN, U2RM, Caen, 14032, France. 7Centre d'Investigation Clinique-Innovations Technologiques, Services de Physiologie-Explorations Fonctionnelles, Hôpital Raymond Poincaré, AP-HP, EA 4497, Université de Versailles-Saint Quentin en Yvelines, Garches, France. 8INSERM, U 955, Créteil, Paris, France.
• Crit. Care Med.. 2014 Mar 1;42(3):565-73.

ObjectivesTo investigate breathing-swallowing interactions in patients with chronic obstructive pulmonary disease requiring noninvasive mechanical ventilation and, if needed, to develop a technical modification of the ventilator designed to eliminate ventilator insufflations during swallowing.DesignWe conducted a prospective, open-label, interventional study.PatientsFifteen consecutive chronic obstructive pulmonary disease patients with exacerbations requiring ICU admission and NIV.InterventionsSwallowing performance and breathing-swallowing interactions were investigated noninvasively by chin electromyography, cervical piezoelectric sensor, and inductive respiratory plethysmography. Two water-bolus sizes (5 and 10 mL) were tested in random order. Swallowing was tested with and without noninvasive mechanical ventilation, in random order. First, a standard mechanical ventilator capable of delivering noninvasive mechanical ventilation was used. Second, a marketed device was equipped with an off-switch for use during swallowing.Measurements And Main ResultsSwallowing performance and breathing-swallowing interactions were investigated noninvasively by chin electromyography, cervical piezoelectric sensor, and inductive respiratory plethysmography. Two water bolus sizes (5 and 10 mL) were tested in random order. Swallowing was tested with and without noninvasive mechanical ventilation in random order. First, a standard mechanical ventilator capable of delivering noninvasive mechanical ventilation was used. Swallowing efficiency, breathing-swallowing synchronization, and Borg Scale dyspnea scores improved significantly with noninvasive mechanical ventilation. However, swallowing induced ventilator triggering followed by autotriggering. To improve patient-ventilator synchrony, a marketed device was equipped with an off-switch for use during swallowing. This device completely eliminated swallowing-induced ventilator triggering and postswallow autotriggering.ConclusionPatients with chronic obstructive pulmonary disease admitted to the ICU for acute exacerbations had abnormal breathing-swallowing interactions and dyspnea, which improved with noninvasive mechanical ventilation. Furthermore, a ventilator device with a simple switch-off pushbutton to eliminate insufflations during swallows prevented swallowing-induced ventilator triggering and postswallow autotriggering.

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