Khirani Sonia, Ramirez Adriana, Delord Vincent, Leroux Karl, Lofaso Frédéric, Hautot Solène, Toussaint Michel, Orlikowski David, Louis Bruno, Fauroux Brigitte
Pediatric Pulmonary Department, Assistance Publique-Hôpitaux de Paris, Hôpital Armand Trousseau, Paris, France. S2A Santé, Ivry sur Seine, France.
Pediatric Pulmonary Department, Assistance Publique-Hôpitaux de Paris, Hôpital Armand Trousseau, Paris, France. Association d'Entraide des Polios et Handicapés Assistance, Suresnes, France.
Respir Care. 2014 Sep;59(9):1329-37. doi: 10.4187/respcare.03031. Epub 2014 May 20.
Daytime mouthpiece ventilation is a useful adjunct to nocturnal noninvasive ventilation (NIV) in patients with neuromuscular disease. The aims of the study were to analyze the practice of mouthpiece ventilation and to evaluate the performance of ventilators for mouthpiece ventilation.
Practice of mouthpiece ventilation was assessed by a questionnaire, and the performance of 6 home ventilators with mouthpiece ventilation was assessed in a bench test using 24 different conditions per ventilator: 3 mouthpieces, a child and an adult patient profile, and 4 ventilatory modes.
Questionnaires were obtained from 30 subjects (mean age 33 ± 11 y) using NIV for 12 ± 7 y. Fifteen subjects used NIV for > 20 h/day, and 11 were totally ventilator-dependent. The subject-reported benefits of mouthpiece ventilation were a reduction in dyspnea (73%) and fatigue (93%) and an improvement in speech (43%) and eating (27%). The bench study showed that none of the ventilators, even those with mouthpiece ventilation software, were able to deliver mouthpiece ventilation without alarms and/or autotriggering in each condition. Alarms and/or ineffective triggering or autotriggering were observed in 135 of the 198 conditions. The occurrence of alarms was more common with a large mouthpiece without a filter compared to a small mouthpiece with a filter (P < .001), but it was not related to the patient profile, the ventilatory mode, or the type of ventilator.
Subjects are satisfied with mouthpiece ventilation. Alarms are common with home ventilators, although less common in those with mouthpiece ventilation software. Improvements in home ventilators are needed to facilitate the expansion of mouthpiece ventilation.
对于神经肌肉疾病患者，日间口含器通气是夜间无创通气（NIV）的一项有用辅助手段。本研究的目的是分析口含器通气的应用情况，并评估用于口含器通气的呼吸机性能。
通过问卷调查对口含器通气的应用情况进行评估，并在台架试验中对6台具备口含器通气功能的家用呼吸机进行性能评估，每台呼吸机采用24种不同条件：3种口含器、儿童和成人患者模型以及4种通气模式。
共获得30名受试者（平均年龄33±11岁）的问卷，这些受试者使用NIV的时间为12±7年。15名受试者每天使用NIV超过20小时，11名受试者完全依赖呼吸机。受试者报告口含器通气的益处包括呼吸困难减轻（73%）、疲劳减轻（93%）、言语能力改善（43%）和进食能力改善（27%）。台架研究表明，即使是具备口含器通气软件的呼吸机，在每种条件下也无法在无警报和/或自动触发的情况下进行口含器通气。在198种条件中的135种观察到警报和/或无效触发或自动触发。与带过滤器的小口径口含器相比，不带过滤器的大口径口含器更常出现警报（P<.001），但警报与患者模型、通气模式或呼吸机类型无关。
受试者对口含器通气感到满意。家用呼吸机警报常见，不过在具备口含器通气软件的呼吸机中较少见。需要改进家用呼吸机以促进口含器通气的推广。
