Respiratory Failure Clinical Trial
— OPTIDEGOfficial title:
Evaluation of Nasal Ventilation on Optimizing Swallowing in Ventilated Neuromuscular Patients
Neuromuscular disorders can be associated with swallowing dysfunction secondary to a
dysfunction of the airway muscles involved in swallowing. The investigators have shown that
respiratory failure may contribute to swallowing dysfunction in patients with neuromuscular
respiratory failure. Furthermore, although tracheostomy has been reported as impairing
swallowing, the investigators have shown that when a tracheostomy is performed in
neuromuscular patients, swallowing improves because it allows the patient to feed while
ventilated.
The investigators now want to evaluate whether non invasive ventilation may have a
beneficial impact on swallowing by making some adjustments to ensure a good synchronisation
between ventilation and swallowing. This could allow avoiding the necessity of a
tracheostomy or a gastrostomy due to swallowing dysfunction and/or malnutrition in
neuromuscular patients.
Swallowing improvement under mechanical ventilation depends on improving the synchronisation
between the patient and the ventilator during swallowing. For that purpose, the
investigators developed a prototype ventilator able to temporarily suspend pressurisation
under the patient's control so that when the patient needs to swallow under mechanical
ventilation he may do so with an inadequate insufflation of the ventilator.
Our objective is to to demonstrate that swallowing is more adapted and easier under nasal
noninvasive ventilation than during spontaneous breathing in neuromuscular patients
requiring prolonged noninvasive ventilation.
In an open monocentric pilot study, the investigators will study 10 neuromuscular patients
usually noninvasively ventilated. The patients will be their own control and their swallow
will be studied during spontaneous breathing and under ventilation with the adapted
ventilator while swallowing boluses of different volumes.
Status | Completed |
Enrollment | 10 |
Est. completion date | May 2013 |
Est. primary completion date | February 2012 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 18 Years and older |
Eligibility |
Inclusion criteria: - Neurologic or Neuromuscular restrictive respiratory failure, excluding bulbar involvement - Hospitalization in the home ventilation unit of the Raymond Poincaré Hospital - day and night non invasive ventilation during >14hours/day - respiratory autonomy of at least one hour of during the day - Ventilation with an assisted and controled mode - Adults =18 years - Stable patient upon inclusion - prior Medical examination - Signed consent form Exclusion Criteria: - Unstable hemodynamics - Respiratory decompensation - Unable to cooperate - Person under guardianship or trusteeship - Pregnant women - Refusal of study participation - Non covered by the social security system |
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Supportive Care
Country | Name | City | State |
---|---|---|---|
France | Raymond Poincare Hospital | Garches |
Lead Sponsor | Collaborator |
---|---|
Centre d'Investigation Clinique et Technologique 805 | Adep Assistance |
France,
Prigent H, Lejaille M, Terzi N, Annane D, Figere M, Orlikowski D, Lofaso F. Effect of a tracheostomy speaking valve on breathing-swallowing interaction. Intensive Care Med. 2012 Jan;38(1):85-90. doi: 10.1007/s00134-011-2417-8. Epub 2011 Nov 24. — View Citation
Terzi N, Orlikowski D, Aegerter P, Lejaille M, Ruquet M, Zalcman G, Fermanian C, Raphael JC, Lofaso F. Breathing-swallowing interaction in neuromuscular patients: a physiological evaluation. Am J Respir Crit Care Med. 2007 Feb 1;175(3):269-76. Epub 2006 Nov 16. — View Citation
Terzi N, Prigent H, Lejaille M, Falaize L, Annane D, Orlikowski D, Lofaso F. Impact of tracheostomy on swallowing performance in Duchenne muscular dystrophy. Neuromuscul Disord. 2010 Aug;20(8):493-8. doi: 10.1016/j.nmd.2010.05.009. Epub 2010 Jun 16. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | impact of non invasive ventilation on swallowing efficiency | Swallowing efficiency under non invasive ventilation will be evaluated by the duration of swallowing of bolus, number of swallow per bolus, number of respiratory cycles per swallowed bolus | 2 Hours | No |
Secondary | Swallow and respiration synchronisation | Number of swallows followed by expiration | 2 Hours | No |
Secondary | Respiratory comfort | Evaluation of the respiratory comfort by the Borg dypnea scale | 2 Hours | No |
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