Mouthpiece ventilation in neuromuscular disorders: Narrative review of technical issues important for clinical success - 12/05/21

Doi : 10.1016/j.rmed.2021.106373

Michel Toussaint ^a,^⁎ , Michelle Chatwin ^b , Miguel R. Gonçalves ^c , Jésus Gonzalez-Bermejo ^d , Joshua O. Benditt ^e , Doug McKim ^f , Jesus Sancho ^g , Brit Hov ^h , Valeria Sansone ⁱ , Hélène Prigent ^j,^k , Annalisa Carlucci ^l , Peter Wijkstra ^m , Barbara Garabelli ⁿ , Joan Escarrabill ^o , Tiago Pinto ^p , Nicolas Audag ^q , Laura Verweij-van den Oudenrijn ^r , Adam Ogna ^s , Wendy Hughes ^t , Christian Devaux ^u , Johann Chaulet ^v , Tiina Andersen ^w
on behalf of the
ENMC Respiratory Therapy Consortium
^a Neuromuscular Excellency Centre VUB- Inkendaal, Center for Home Mechanical Ventilation ZH Inkendaal Rehabilitation Hospital, Brussels, Belgium
^b Clinical and Academic Department of Sleep and Breathing, Royal Brompton, London, UK
^c Noninvasive Ventilatory Support Unit, Emergency and Intensive Care Medicine Department, Pulmonology Department, São João University Hospital. Faculty of Medicine, University of Porto, Portugal
^d Sorbonne-Université, Service de pneumologie et réanimation respiratoire, Groupe hospitalier de la Pitié-Salpêtrière-Charles Foix, Paris, France
^e University of Washington Medical Center, Seattle, USA
^f University of Ottawa, CANVent Respiratory Services, The Ottawa Hospital Sleep Centre, Canada
^g Respiratory Care Unit, Respiratory Medicine Department, Hospital Clínico Universitario, Health Research Institute INCLIVA, Valencia, Spain
^h Paediatric Department, Oslo University Hospital, Oslo, Norway
ⁱ The NEMO Clinical Center, Neurorehabilitation Unit, University of Milan, Italy
^j Service de Physiologie et Explorations Fonctionnelles, Hôpital Raymond Poincaré, GHU PIFO, APHP, Garches, France
^k UFR Simone Veil, Université de Versailles, Saint Quentin en Yvelines, Montigny le Bretonneux, France
^l Pulmonary Rehabilitation and Weaning Center, Istituti Clinici Scientifici-Maugeri, Pavia, Italy
^m Department of Home Mechanical Ventilation and Pulmonary Diseases, University Medical Center Groningen, Groningen, the Netherlands
ⁿ Respiratory Unit, Neuromuscular OmniCentre (NeMO), Niguarda Hospital, Milan, Italy
^o Hospital Clínic-Barcelona & Master Plan For Respiratory Diseases, Ministry of Health (Government of Catalonia), Barcelona, Spain
^p Lung Function and Ventilation Unit - Pulmonology Department, São João University Hospital, Porto, Portugal
^q Unité de Pneumologie pédiatrique, Cliniques universitaires Saint-Luc, Brussels, Belgium
^r Wilhelmina Kinderziekenhuis, Divisie Kinderen, Centrum voor Thuisbeademing, Utrecht, the Netherlands
^s Servizio di pneumologia, Ospedale Regionale di Locarno, Switzerland
^t Myotubular Trust, UK
^u Département des affaires Médicales, AFM, France
^v France
^w Norwegian Advisory Unit on Home Mechanical Ventilation, Thoracic Department, Haukeland University Hospital, Bergen, Norway

^∗Corresponding author. Centre for Home Mechanical Ventilation and Specialized Centre for Neuromuscular Diseases, Inkendaal Rehabilitation Hospital, Revalidatie Ziekenhuis Inkendaal, Inkendaalstraat, 1, 1602, lezenbeek, Belgium.Centre for Home Mechanical Ventilation and Specialized Centre for Neuromuscular DiseasesInkendaal Rehabilitation HospitalRevalidatie Ziekenhuis InkendaalInkendaalstraat, 1lezenbeek1602Belgium

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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Highlights

•	Mouthpiece ventilation (MPV) represents a difficult task for home ventilators due to rapidly changing load conditions.
•	Circuit leakage is a natural part of MPV.
•	Volume-cycled ventilation copes better with circuit leakage than pressure-cycled ventilation.
•	Volume-cycled ventilation is considered as the first line mode to initiate MPV since it allows intermittent lip sealing without leak compensation.
•	Ventilators equipped with a dedicated MPV mode provide 10 new technological properties which favors the use of MPV at home.

Le texte complet de cet article est disponible en PDF.

Keywords : MPV, Mouthpiece ventilation, NMD, Non-invasive ventilation, Neuromuscular disorders

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Mouthpiece ventilation in neuromuscular disorders: Narrative review of technical issues important for clinical success - 12/05/21

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