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Effect of a tracheostomy speaking valve on breathing–swallowing interaction

Hélène Prigent| Michèle Lejaille| Nicolas Terzi| Djillali Annane| Marjorie Figere| David Orlikowski| Frédéric Lofaso
Original
Volume 38, Issue 1 / January , 2012

Pages 85 - 90

Abstract

Purpose

Expiratory flow towards the upper airway after swallowing serves to expel liquid or food particles misdirected towards the trachea during swallowing. However, expiration may not occur consistently after swallowing in tracheostomised patients with an open tracheostomy tube. We investigated the effect of a speaking valve (SV) on breathing–swallowing interactions and on the volume expelled through the upper airway after swallowing.

Methods

Eight tracheostomised neuromuscular patients who were able to breathe spontaneously were studied with and without an SV. Breathing–swallowing interactions were investigated by chin electromyography, cervical piezoelectric sensor, and nasal and tracheal flow recording. Three water-bolus sizes (5, 10, and 15 mL) were tested in random order.

Results

Swallowing characteristics and breathing–swallowing synchronisation were not influenced by SV use. However, expiratory flow towards the upper airway after swallowing was negligible without the SV and was restored by adding the SV.

Conclusion

In tracheostomised patients, protective expiration towards the upper airway after swallowing is restored by the use of an SV.

Keywords

References

  1. Bonanno PC (1971) Swallowing dysfunction after tracheostomy. Ann Surg 174:29–33
    • View reference on PubMed
    • View reference on publisher's website
  2. Feldman SA, Deal CW, Urquhart W (1966) Disturbance of swallowing after tracheostomy. Lancet 1:954–955
    • View reference on PubMed
    • View reference on publisher's website
  3. Buckwalter JA, Sasaki CT (1984) Effect of tracheotomy on laryngeal function. Otolaryngol Clin North Am 17:41–48
    • View reference on PubMed
  4. DeVita MA, Spierer-Rundback L (1990) Swallowing disorders in patients with prolonged orotracheal intubation or tracheostomy tubes. Crit Care Med 18:1328–1330
    • View reference on PubMed
    • View reference on publisher's website
  5. Betts RH (1965) Post-tracheostomy aspiration. N Engl J Med 273:155
    • View reference on PubMed
    • View reference on publisher's website
  6. Eibling DE, Gross RD (1996) Subglottic air pressure: a key component of swallowing efficiency. Ann Otol Rhinol Laryngol 105:253–258
    • View reference on PubMed
  7. Suiter DM, McCullough GH, Powell PW (2003) Effects of cuff deflation and one-way tracheostomy speaking valve placement on swallow physiology. Dysphagia 18:284–292
    • View reference on PubMed
    • View reference on publisher's website
  8. Gross RD, Mahlmann J, Grayhack JP (2003) Physiologic effects of open and closed tracheostomy tubes on the pharyngeal swallow. Ann Otol Rhinol Laryngol 112:143–152
    • View reference on PubMed
  9. Elpern EH, Borkgren Okonek M, Bacon M, Gerstung C, Skrzynski M (2000) Effect of the Passy-Muir tracheostomy speaking valve on pulmonary aspiration in adults. Heart Lung 29:287–293
    • View reference on PubMed
    • View reference on publisher's website
  10. Stachler RJ, Hamlet SL, Choi J, Fleming S (1996) Scintigraphic quantification of aspiration reduction with the Passy-Muir valve. Laryngoscope 106:231–234
    • View reference on PubMed
    • View reference on publisher's website
  11. Smith J, Wolkove N, Colacone A, Kreisman H (1989) Coordination of eating, drinking and breathing in adults. Chest 96:578–582
    • View reference on PubMed
    • View reference on publisher's website
  12. Martin BJ, Logemann JA, Shaker R, Dodds WJ (1994) Coordination between respiration and swallowing: respiratory phase relationships and temporal integration. J Appl Physiol 76:714–723
    • View reference on PubMed
  13. Nishino T, Yonezawa T, Honda Y (1985) Effects of swallowing on the pattern of continuous respiration in human adults. Am Rev Respir Dis 132:1219–1222
    • View reference on PubMed
  14. Paydarfar D, Gilbert RJ, Poppel CS, Nassab PF (1995) Respiratory phase resetting and airflow changes induced by swallowing in humans. J Physiol 483(Pt 1):273–288
    • View reference on PubMed
  15. Martin-Harris B, Brodsky MB, Price CC, Michel Y, Walters B (2003) Temporal coordination of pharyngeal and laryngeal dynamics with breathing during swallowing: single liquid swallows. J Appl Physiol 94:1735–1743
    • View reference on PubMed
  16. Boden K, Cedborg AI, Eriksson LI, Hedstrom HW, Kuylenstierna R, Sundman E, Ekberg O (2009) Swallowing and respiratory pattern in young healthy individuals recorded with high temporal resolution. Neurogastroenterol Motil 21:1163 e1101
    • View reference on PubMed
    • View reference on publisher's website
  17. Cohn MA, Rao AS, Broudy M, Birch S, Watson H, Atkins N, Davis B, Stott FD, Sackner MA (1982) The respiratory inductive plethysmograph: a new non-invasive monitor of respiration. Bull Eur Physiopathol Respir 18:643–658
    • View reference on PubMed
  18. Ertekin C, Pehlivan M, Aydogdu I, Ertas M, Uludag B, Celebi G, Colakoglu Z, Sagduyu A, Yuceyar N (1995) An electrophysiological investigation of deglutition in man. Muscle Nerve 18:1177–1186
    • View reference on PubMed
    • View reference on publisher's website
  19. Terzi N, Orlikowski D, Aegerter P, Lejaille M, Ruquet M, Zalcman G, Fermanian C, Raphael JC, Lofaso F (2007) Breathing–swallowing interaction in neuromuscular patients: a physiological evaluation. Am J Respir Crit Care Med 175:269–276
    • View reference on PubMed
    • View reference on publisher's website
  20. Hardemark Cedborg AI, Sundman E, Boden K, Hedstrom HW, Kuylenstierna R, Ekberg O, Eriksson LI (2009) Co-ordination of spontaneous swallowing with respiratory airflow and diaphragmatic and abdominal muscle activity in healthy adult humans. Exp Physiol 94:459–468
    • View reference on PubMed
    • View reference on publisher's website
  21. Martin-Harris B, Brodsky MB, Michel Y, Ford CL, Walters B, Heffner J (2005) Breathing and swallowing dynamics across the adult lifespan. Arch Otolaryngol Head Neck Surg 131:762–770
    • View reference on PubMed
    • View reference on publisher's website
  22. Ikari T, Sasaki CT (1980) Glottic closure reflex: control mechanisms. Ann Otol Rhinol Laryngol 89:220–224
    • View reference on PubMed
  23. Ertekin C, Aydogdu I, Yuceyar N, Kiylioglu N, Tarlaci S, Uludag B (2000) Pathophysiological mechanisms of oropharyngeal dysphagia in amyotrophic lateral sclerosis. Brain 123(Pt 1):125–140
    • View reference on PubMed
    • View reference on publisher's website
  24. Ertekin C, Yuceyar N, Aydogdu, Karasoy H (2001) Electrophysiological evaluation of oropharyngeal swallowing in myotonic dystrophy. J Neurol Neurosurg Psychiatry 70:363–371
  25. Gross RD, Atwood CW Jr, Ross SB, Olszewski JW, Eichhorn KA (2009) The coordination of breathing and swallowing in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 179:559–565
    • View reference on PubMed
    • View reference on publisher's website
  26. Nishino T, Hasegawa R, Ide T, Isono S (1998) Hypercapnia enhances the development of coughing during continuous infusion of water into the pharynx. Am J Respir Crit Care Med 157:815–821
    • View reference on PubMed
  27. Kijima M, Isono S, Nishino T (1999) Coordination of swallowing and phases of respiration during added respiratory loads in awake subjects. Am J Respir Crit Care Med 159:1898–1902
    • View reference on PubMed
  28. Pane M, Vasta I, Messina S, Sorleti D, Aloysius A, Sciarra F, Mangiola F, Kinali M, Ricci E, Mercuri E (2006) Feeding problems and weight gain in Duchenne muscular dystrophy. Eur J Paediatr Neurol 10:231–236
    • View reference on PubMed
    • View reference on publisher's website
  29. Hadjikoutis S, Pickersgill TP, Dawson K, Wiles CM (2000) Abnormal patterns of breathing during swallowing in neurological disorders. Brain 123(Pt 9):1863–1873
    • View reference on PubMed
    • View reference on publisher's website
  30. Terzi N, Prigent H, Lejaille M, Falaize L, Annane D, Orlikowski D, Lofaso F (2010) Impact of tracheostomy on swallowing performance in Duchenne muscular dystrophy. Neuromuscul Disord 20:493–498
    • View reference on PubMed
    • View reference on publisher's website

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