Speech effects of a speaking valve versus external PEEP in tracheostomized ventilator-dependent neuromuscular patients.

Abstract

Many patients with respiratory failure related to neuromuscular disease receive chronic invasive ventilation through a tracheostomy. Improving quality of life, of which speech is an important component, is a major goal in these patients. We compared the effects on breathing and speech of low-level positive end-expiratory pressure (PEEP, 5 cmH(2)O) and of a Passy-Muir speaking valve (PMV) during assist-control ventilation. We studied ten patients with neuromuscular disorders, between December 2008 and April 2009. Flow was measured using a pneumotachograph. Microphone speech recordings were subjected to both quantitative measurements and qualitative assessments; the latter consisted of both an intelligibility score (using a French adaptation of the Frenchay Dysarthria Assessment) and a perceptual score determined by two speech therapists. Text reading time, perceptive score, intelligibility score, speech comfort, and respiratory comfort were similar with PEEP and PMV. During speech with 5 cmH(2)O PEEP, six of the ten patients had no return of expiratory gas to the expiratory line and, therefore, had the entire insufflated volume available for speech, a condition met during PMV use in all patients. During speech, the respiratory rate increased by at least 3 cycles/min above the backup rate in seven patients with PEEP and in none of the patients with PMV. Low-level PEEP is as effective as PMV in ensuring good speech quality, which might be explained by sealed expiratory line with low-level PEEP and/or respiratory rate increase during speech with PEEP observed in most of the patients.