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Leivo-Korpela S, Rantala HA, Piili RP, Lehtimäki L, Lehto JT. Palliation of Dyspnea With Mouthpiece Ventilation in Patients With Chronic Obstructive Pulmonary Disease: A Pilot Feasibility Study. J Palliat Med 2023; 26:1261-1265. [PMID: 37155710 DOI: 10.1089/jpm.2023.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Background: Mouthpiece ventilation (MPV) reduces hypoventilation, but its efficacy in relieving dyspnea in patients with acute chronic obstructive pulmonary disease exacerbation (AECOPD) is unclear. Objective: To assess the feasibility of MPV in relieving dyspnea among patients with AECOPD. Methods: In this prospective single-arm pilot study, the change in dyspnea on numeric rating scale (NRS) after using MPV and side effects of the treatment were studied in 18 patients with AECOPD. Results: The median decrease in dyspnea was 1.5 (95% confidence interval = 0.0-2.5, p = 0.006) on NRS after the intervention lasting a median of 16.9 minutes. Of the patients, 61% found MPV beneficial. The use of MPV did not increase the sense of anxiety or pain. Conclusions: MPV is feasible and may relieve dyspnea in patients with AECOPD, but the intervention needs further evaluation. clinicaltrials.gov study number: NCT03025425.
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Affiliation(s)
- Sirpa Leivo-Korpela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre and Department of Geriatrics, Tampere University Hospital, Tampere, Finland
| | - Heidi A Rantala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland
| | - Reetta P Piili
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre and Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Juho T Lehto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre and Department of Oncology, Tampere University Hospital, Tampere, Finland
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Wadsworth BM, Kruger PS, Hukins CA, Modderman GA, Brown D, Paratz JD. The feasibility of using mouthpiece ventilation in the intensive care unit for post-extubation breathing support after acute tetraplegia. Spinal Cord 2023; 61:330-337. [PMID: 36932257 PMCID: PMC10328823 DOI: 10.1038/s41393-023-00889-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023]
Abstract
STUDY DESIGN A prospective cohort of patients with acute tetraplegia. OBJECTIVES This study aimed to determine the feasibility of using mouthpiece ventilation (MPV) in the intensive care unit (ICU) for patients who are extubated after suffering an acute cervical spinal cord injury (CSCI). SETTING ICU, Princess Alexandra Hospital, Brisbane Australia. METHODS New admissions to ICU in the 14 months between April 2017 and June 2018 with a CSCI who underwent intubation were assessed for inclusion. MPV was provided to consenting participants (who were deemed likely to be able to maintain ventilation on their own) at the time of extubation and was utilised in addition to standard care while participants were awake. MPV settings, usage, and support hours to educate and facilitate MPV were collected. Feedback from participants and clinical staff was gathered throughout the study. Pre- and post-extubation measures of forced vital capacity (FVC), the frequency of endotracheal suction of sputum, and gas exchange using ventilation-perfusion ratios were recorded along with the incidence of reintubation. RESULTS Fourteen participated in utilising MPV with 16 episodes of extubation. The average time per participant to have MPV titrated and bedside data collected was 178 minutes. Data from 16 episodes of extubation have been included. Three of the 14 participants failed initial extubation. Feedback from participants and clinicians has been positive and constructive, enabling MPV settings to be adapted to the person with acute CSCI during this pilot study. CONCLUSION MPV is feasible to use post-extubation for people with CSCI in ICU. Pressure control mode MPV was deemed the most suitable for newly extubated acute CSCI patients. Intensive clinical support is required initially to provide education prior to MPV, and at the time of extubation for both patient and treating clinicians. Both report it to be a useful adjunct to ICU treatment.
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Affiliation(s)
- Brooke M Wadsworth
- Physiotherapy Department, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Woolloongabba, QLD, Australia.
| | - Peter S Kruger
- Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Department of Anaesthesiology and Critical Care, The University of Queensland, St Lucia, QLD, Australia
- Intensive care, Greenslopes Private Hospital, Greenslopes, QLD, Australia
| | - Craig A Hukins
- Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Gabrielle A Modderman
- Physiotherapy Department, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Duncan Brown
- Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Jennifer D Paratz
- Menzies Health Institute, Griffith University, Griffith, QLD, Australia
- Burns, Trauma & Critical Care Research Centre, School of Medicine, The University of Queensland, St Lucia, QLD, Australia
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Toussaint M, Chatwin M, Gonçalves MR, Gonzalez-Bermejo J, Benditt JO, McKim D, Sancho J, Hov B, Sansone V, Prigent H, Carlucci A, Wijkstra P, Garabelli B, Escarrabill J, Pinto T, Audag N, Verweij-van den Oudenrijn L, Ogna A, Hughes W, Devaux C, Chaulet J, Andersen T. Mouthpiece ventilation in neuromuscular disorders: Narrative review of technical issues important for clinical success. Respir Med 2021; 180:106373. [PMID: 33798870 DOI: 10.1016/j.rmed.2021.106373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
In neuromuscular disorders (NMDs), nocturnal non-invasive ventilation (NIV) via a nasal mask is offered when hypercapnic respiratory failure occurs. With disease progression, nocturnal NIV needs to be extended into the daytime. Mouthpiece ventilation (MPV) is an option for daytime NIV. MPV represents a difficult task for home ventilators due to rapidly changing load conditions resulting from intermittent connections and disconnections from MPV circuit. The 252nd ENMC International Expert Workshop, held March 6th to 8th 2020 in Amsterdam, reported general guidelines for management of daytime MPV in NMDs. This report could not present all the detail regarding the technical issues important for clinical success of MPV. Based on the expert workshop discussions and the evidence from existing studies, the current narrative review aims to identify the technical issues of MPV and offers guidance via a decisional algorithm and educational figures providing relevant information that is important for successful implementation of MPV.
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Affiliation(s)
- Michel Toussaint
- Neuromuscular Excellency Centre VUB- Inkendaal, Center for Home Mechanical Ventilation ZH Inkendaal Rehabilitation Hospital, Brussels, Belgium.
| | - Michelle Chatwin
- Clinical and Academic Department of Sleep and Breathing, Royal Brompton, London, UK.
| | - Miguel R Gonçalves
- Noninvasive Ventilatory Support Unit, Emergency and Intensive Care Medicine Department, Pulmonology Department, São João University Hospital. Faculty of Medicine, University of Porto, Portugal.
| | - Jésus Gonzalez-Bermejo
- Sorbonne-Université, Service de pneumologie et réanimation respiratoire, Groupe hospitalier de la Pitié-Salpêtrière-Charles Foix, Paris, France.
| | | | - Doug McKim
- University of Ottawa, CANVent Respiratory Services, The Ottawa Hospital Sleep Centre, Canada.
| | - Jesus Sancho
- Respiratory Care Unit, Respiratory Medicine Department, Hospital Clínico Universitario, Health Research Institute INCLIVA, Valencia, Spain.
| | - Brit Hov
- Paediatric Department, Oslo University Hospital, Oslo, Norway.
| | - Valeria Sansone
- The NEMO Clinical Center, Neurorehabilitation Unit, University of Milan, Italy.
| | - Hélène Prigent
- Service de Physiologie et Explorations Fonctionnelles, Hôpital Raymond Poincaré, GHU PIFO, APHP, Garches, France; UFR Simone Veil, Université de Versailles, Saint Quentin en Yvelines, Montigny le Bretonneux, France.
| | - Annalisa Carlucci
- Pulmonary Rehabilitation and Weaning Center, Istituti Clinici Scientifici-Maugeri, Pavia, Italy.
| | - Peter Wijkstra
- Department of Home Mechanical Ventilation and Pulmonary Diseases, University Medical Center Groningen, Groningen, the Netherlands.
| | - Barbara Garabelli
- Respiratory Unit, Neuromuscular OmniCentre (NeMO), Niguarda Hospital, Milan, Italy.
| | - Joan Escarrabill
- Hospital Clínic-Barcelona & Master Plan For Respiratory Diseases, Ministry of Health (Government of Catalonia), Barcelona, Spain.
| | - Tiago Pinto
- Lung Function and Ventilation Unit - Pulmonology Department, São João University Hospital, Porto, Portugal.
| | - Nicolas Audag
- Unité de Pneumologie pédiatrique, Cliniques universitaires Saint-Luc, Brussels, Belgium.
| | | | - Adam Ogna
- Servizio di pneumologia, Ospedale Regionale di Locarno, Switzerland.
| | | | | | | | - Tiina Andersen
- Norwegian Advisory Unit on Home Mechanical Ventilation, Thoracic Department, Haukeland University Hospital, Bergen, Norway.
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Chatwin M, Gonçalves M, Gonzalez-Bermejo J, Toussaint M. [Mouthpiece ventilation in neuromuscular diseases]. Med Sci (Paris) 2021; 36 Hors série n° 2:65-75. [PMID: 33427643 DOI: 10.1051/medsci/2020271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Le document qui suit est la traduction intégrale du compte rendu établi à l’occasion du 252e atelier international ENMC consacré, du 6 ou 8 mars 2020, au « Développement de recommandations pour l’utilisation de la ventilation par embout buccal dans les maladies neuromusculaires », et publié très récemment dans la revue Neuromuscular Disorders (M. Chatwin, M. Gonçalves, J. Gonzalez-Bermejo, M. Toussaint, et al. 252nd ENMC international workshop: Developing best practice guidelines for management of mouthpiece ventilation in neuromuscular disorders. March 6th to 8th 2020, Amsterdam, the Netherlands. Neuromuscular Disorders 2020 ; 30 : 772–81. https://doi.org/10.1016/j.nmd.2020.07.008).
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Affiliation(s)
- Michelle Chatwin
- Clinical and Academic Department of Sleep and Breathing, Royal Brompton Hospital, London SW3 6NP, Royaume-Uni
| | - Miguel Gonçalves
- Noninvasive Ventilatory Support Unit, Emergency and Intensive Care Medicine Department. Pulmonology Department, São João University Hospital. Faculty of Medicine, University of Porto, Portugal
| | - Jesus Gonzalez-Bermejo
- Service de Pneumologie et Réanimation Respiratoire, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Michel Toussaint
- Centre for Home Mechanical Ventilation and Specialized Centre for Neuromuscular Diseases, Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgique
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Lehto JT, Leivo-Korpela S, Korhonen T, Rantala HA, Raunio H, Lyly-Yrjänäinen T, Lehtimäki L. Mouthpiece ventilation in the management of dyspnea: A single-arm pilot study. Palliat Med 2020; 34:1274-1278. [PMID: 32579086 PMCID: PMC7495670 DOI: 10.1177/0269216320935003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Noninvasive ventilation may relieve dyspnea in advanced diseases, but noninvasive ventilation through mouthpiece has not been tested in palliative care. AIM To assess the feasibility of mouthpiece ventilation in relieving dyspnea among patients with advanced disease. DESIGN In this prospective single-arm pilot study, the change in dyspnea by mouthpiece ventilation was measured with numeric rating scale (0-10) and 100-mm visual analogue scale. Overall, benefit and adverse events of the therapy were also assessed. SETTING/PARTICIPANTS Twenty-two patients with an advanced disease and dyspnea from the Tampere University Hospital or Pirkanmaa Hospice were treated with mouthpiece ventilation. The patients used mouthpiece ventilation as long as they preferred, but for a minimum of 5 min. RESULTS After the treatment period lasting a median of 13.5 min, mean decrease in dyspnea was -1.1 (95 % confidence interval = -2.2 to -0.1, p = 0.034) on numeric rating scale and -11.8 mm (95 % confidence interval = -19.9 to -3.7, p = 0.006) on visual analogue scale. Nonetheless, there was a high variability in this effect between individual patients. About half of the patients found mouthpiece ventilation beneficial. No serious adverse events occurred, but dry mouth was the most common adverse event. Anxiety did not increase with mouthpiece ventilation. CONCLUSION Mouthpiece ventilation is feasible and may relieve dyspnea in some patients with an advanced disease. Further studies are needed, and these might concentrate on stable patients in early palliative care. Before initiation, this study was registered at clinicaltrials.gov (study no. NCT03012737).
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Affiliation(s)
- Juho T Lehto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Palliative Care Centre and Tays Cancer Centre, Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Sirpa Leivo-Korpela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland
| | - Tarja Korhonen
- Pirkanmaa Hospice, Palliative Care Centre, Tampere University Hospital, Tampere, Finland
| | - Heidi A Rantala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland
| | - Hanna Raunio
- Palliative Care Centre and Tays Cancer Centre, Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Tiina Lyly-Yrjänäinen
- Palliative Care Centre and Tays Cancer Centre, Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland
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Chatwin M, Gonçalves M, Gonzalez-Bermejo J, Toussaint M. 252nd ENMC international workshop: Developing best practice guidelines for management of mouthpiece ventilation in neuromuscular disorders. March 6th to 8th 2020, Amsterdam, the Netherlands. Neuromuscul Disord 2020; 30:772-781. [PMID: 32859499 PMCID: PMC7374135 DOI: 10.1016/j.nmd.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Michelle Chatwin
- Clincial and Academic Department of Sleep and Breathing, Royal Brompton Hospital, London SW3 6NP, United Kingdom.
| | - Miguel Gonçalves
- Noninvasive Ventilatory Support Unit, Emergency and Intensive Care Medicine Department. Pulmonology Department, São João University Hospital. Faculty of Medicine, University of Porto, Portugal
| | - Jesus Gonzalez-Bermejo
- Service de Pneumologie et Réanimation Respiratoire, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Michel Toussaint
- Centre for Home Mechanical Ventilation and Specialized Centre for Neuromuscular Diseases, Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
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Toussaint M, Chatwin M, Verhulst S, Reychler G. Preference of neuromuscular patients regarding equipment for daytime mouthpiece ventilation: A randomized crossover study. CLINICAL RESPIRATORY JOURNAL 2019; 14:214-221. [DOI: 10.1111/crj.13118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 11/13/2019] [Accepted: 11/29/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Michel Toussaint
- Centre for Home Mechanical Ventilation and Neuromuscular Disorders Department of Rehabilitation Rehabilitation Hospital Inkendaal Vlezenbeek Belgium
| | - Michelle Chatwin
- Clinical and Academic Department of Sleep and Breathing Royal Brompton Hospital S Foundation Trust Royal Brompton & Harefield NH London UK
| | - Stijn Verhulst
- Department of Pediatrics Antwerp University Hospital and Lab of Experimental Medicine and Pediatrics University of Antwerp Antwerp Belgium
| | - Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC) Université Catholique de Louvain Pôle de Pneumologie, ORL & Dermatologie Brussels Belgium
- Service de Pneumologie Cliniques Universitaires Saint‐Luc Brussels Belgium
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Fagevik Olsén M, Lannefors L, Westerdahl E. Positive expiratory pressure - Common clinical applications and physiological effects. Respir Med 2014; 109:297-307. [PMID: 25573419 DOI: 10.1016/j.rmed.2014.11.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 10/24/2014] [Accepted: 11/02/2014] [Indexed: 12/01/2022]
Abstract
Breathing out against resistance, in order to achieve positive expiratory pressure (PEP), is applied by many patient groups. Pursed lips breathing and a variety of devices can be used to create the resistance giving the increased expiratory pressure. Effects on pulmonary outcomes have been discussed in several publications, but the expected underlying physiology of the effect is seldom discussed. The aim of this article is to describe the purpose, performance, clinical application and underlying physiology of PEP when it is used to increase lung volumes, decrease hyperinflation or improve airway clearance. In clinical practice, the instruction how to use an expiratory resistance is of major importance since it varies. Different breathing patterns during PEP increase or reduce expiratory flow, result in movement of EPP centrally or peripherally and can increase or decrease lung volume. It is therefore necessary to give the right instructions to obtain the desired effects. As the different PEP techniques are being used by diverse patient groups it is not possible to give standard instructions. Based on the information given in this article the instructions have to be adjusted to give the optimal effect. There is no consensus regarding optimal treatment frequency and number of cycles included in each treatment session and must also be individualized. In future research, more precise descriptions are needed about physiological aims and specific instructions of how the treatments have been performed to assure as good treatment quality as possible and to be able to evaluate and compare treatment effects.
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Affiliation(s)
- Monika Fagevik Olsén
- Department of Physical Therapy and Occupational Therapy, Sahlgrenska University Hospital, Sweden; Department of Physical Therapy, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Gastrosurgical Research & Education, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
| | - Louise Lannefors
- Cystic Fibrosis Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Elisabeth Westerdahl
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden; School of Health and Medical Sciences, Örebro University, Sweden
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Open circuit mouthpiece ventilation: Concise clinical review. REVISTA PORTUGUESA DE PNEUMOLOGIA 2014; 20:211-8. [PMID: 24841239 DOI: 10.1016/j.rppneu.2014.03.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/16/2014] [Accepted: 03/24/2014] [Indexed: 11/22/2022] Open
Abstract
In 2013 new "mouthpiece ventilation" modes are being introduced to commercially available portable ventilators. Despite this, there is little knowledge of how to use noninvasive intermittent positive pressure ventilation (NIV) as opposed to bi-level positive airway pressure (PAP) and both have almost exclusively been reported to have been used via nasal or oro-nasal interfaces rather than via a simple mouthpiece. Non-invasive ventilation is often reported as failing because of airway secretion encumbrance, because of hypercapnia due to inadequate bi-level PAP settings, or poor interface tolerance. The latter can be caused by factors such as excessive pressure on the face from poor fit, excessive oral air leak, anxiety, claustrophobia, and patient-ventilator dys-synchrony. Thus, the interface plays a crucial role in tolerance and effectiveness. Interfaces that cover the nose and/or nose and mouth (oro-nasal) are the most commonly used but are more likely to cause skin breakdown and claustrophobia. Most associated drawbacks can be avoided by using mouthpiece NIV. Open-circuit mouthpiece NIV is being used by large populations in some centers for daytime ventilatory support and complements nocturnal NIV via "mask" interfaces for nocturnal ventilatory support. Mouthpiece NIV is also being used for sleep with the mouthpiece fixed in place by a lip-covering flange. Small 15 and 22mm angled mouthpieces and straw-type mouthpieces are the most commonly used. NIV via mouthpiece is being used as an effective alternative to ventilatory support via tracheostomy tube (TMV) and is associated with a reduced risk of pneumonias and other respiratory complications. Its use facilitates "air-stacking" to improve cough, speech, and pulmonary compliance, all of which better maintain quality of life for patients with neuromuscular diseases (NMDs) than the invasive alternatives. Considering these benefits and the new availability of mouthpiece ventilator modes, wider knowledge of this technique is now warranted. This review highlights the indications, techniques, advantages and disadvantages of mouthpiece NIV.
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Bibliography. Current world literature. Curr Opin Pulm Med 2009; 15:170-7. [PMID: 19225311 DOI: 10.1097/mcp.0b013e3283276f69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This bibliography is compiled by clinicians from the journals listed at the end of this publication. It is based on literature entered into our database between 1 November 2007 and 31 October 2008 (articles are generally added to the database about two and a half months after publication). In addition, the bibliography contains every paper annotated by reviewers; these references were obtained from a variety of bibliographic databases and published between the beginning of the review period and the time of going to press. The bibliography has been grouped into topics that relate to the reviews in this issue.
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