Coordination between respiration and swallowing during non-invasive positive pressure ventilation
Coordination between respiration and swallowing during non-invasive positive pressure ventilation
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DOI：
10.1111/resp.12790
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发表时间：
2016-08-01
期刊：
影响因子：
6.9
通讯作者：
Oku, Yoshitaka
中科院分区：
文献类型：
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作者：
Hori, Ryuji;Isaka, Masaaki;Oku, Yoshitaka
背景与目的本研究的目的是验证无创正压通气中无声误吸风险增加的假设。方法通过同时监测控制、持续气道正压（CPAP）和双水平气道正压（BiPAP）三种不同状态下的呼吸流量、喉部运动和吞咽声，分析12名青年志愿者和10名老年志愿者呼吸与吞咽的协调性。以吞咽后吸气发生率为因变量，各相关变量为自变量，进行逐步多元回归分析。结果两组患者BiPAP组吞咽后吸气发生率均高于对照组和CPAP组。提取重复唾液吞咽试验计数和吞咽非吸气流发生率作为BiPAP治疗期间吞咽后吸气风险的预测变量。结论不论年龄大小，使用BiPAP后咽吸发生率均增加。结果提示，在BiPAP模式下，吞咽非吸气流可能触发吸气支持，导致误吸风险。我们评估了健康受试者在无创人工通气时呼吸和吞咽的协调性，发现使用BiPAP时吞咽后吸气的发生率增加。结果表明，在BiPAP治疗期间，SNIF可能触发吸气支持，增加误吸的风险。
Background and objectiveThe purpose of this study was to test the hypothesis that the risk of silent aspiration is increased in non-invasive positive pressure ventilation.MethodsWe analysed the coordination between respiration and swallowing, in 12 young volunteers and 10 elder volunteers, by simultaneously monitoring respiratory flow, laryngeal movement and swallowing sound in three different conditions: control, continuous positive airway pressure (CPAP), and bi-level positive airway pressure (BiPAP). A step-wise multiple regression analysis was performed with the occurrence rate of inspiration after swallows as the dependent variable and various correlated variables as the independent variables.ResultsIn both subject groups, the occurrence rate of inspiration after swallow was greater with BiPAP compared with control and CPAP conditions. Repetitive saliva swallowing test count and swallow non-inspiratory flow occurrence rate were extracted as predictor variables for risk of inspiration after swallows during BiPAP treatment.ConclusionWe found that the occurrence rate of inspiration after swallow is increased with BiPAP use irrespective of age. The results suggest that swallow non-inspiratory flow may trigger inspiratory support in the BiPAP mode, resulting in a risk of aspiration.We evaluated the coordination between respiration and swallowing during non-invasive artificial ventilation in healthy subjects and found that the occurrence rate of inspiration after swallowing is increased while using BiPAP. The results suggest that SNIF may trigger inspiratory support during BiPAP treatment, increasing the risk of aspiration.