Swallowing with Noninvasive Positive-Pressure Ventilation (NPPV) in Individuals with Muscular Dystrophy: A Qualitative Analysis

Authors

Deanna Britton, Portland State UniversityFollow
Jeannette D. Hoit, University of Arizona
Joshua O. Benditt, University of Washington Medical Center
Justine Poon, Vasona Creek Healthcare Center
Meghan R. Hansen, Portland State UniversityFollow
Carolyn R. Baylor, University of Washington
Kathryn M. Yorkston, University of WashingtonFollow

Published In

Dysphagia

Document Type

Citation

Publication Date

2020

Abstract

The purpose of the study is to describe experiences of swallowing with two forms of noninvasive positive-pressure ventilation (NPPV): mouthpiece NPPV (M-NPPV) and nasal bilevel positive airway pressure (BPAP) in people with muscular dystrophy. Ten men (ages 22–42 years; M = 29.3; SD = 7.1) with muscular dystrophy (9 with Duchenne’s; 1 with Becker’s) completed the Eating Assessment Tool (EAT-10; Ann Otol Rhinol Laryngol 117(12):919-924 [33]) and took part in semi-structured interviews. The interviews were audio recorded, transcribed, and verified. Phenomenological qualitative research methods were used to code (Dedoose.com) and develop themes. All participants affirmed dysphagia symptoms via responses on the EAT-10 (M = 11.3; SD = 6.38; Range = 3–22) and reported eating and drinking with M-NPPV and, to a lesser extent, nasal BPAP. Analysis of interview data revealed three primary themes: (1) M-NPPV improves the eating/drinking experience: Most indicated that using M-NPPV reduced swallowing-related dyspnea. (2) NPPV affects breathing–swallowing coordination: Participants described challenges and compensations in coordinating swallowing with ventilator-delivered inspirations, and that the time needed to chew solid foods between ventilator breaths may lead to dyspnea and fatigue. (3) M-NPPV aids cough effectiveness: Participants described improved cough strength following large M-NPPV delivered inspirations (with or without breath stacking). Although breathing–swallowing coordination is challenging with NPPV, participants reported that eating and drinking is more comfortable than when not using it. Overall, eating and drinking with NPPV delivered via a mouthpiece is preferred and is likely safer for swallowing than with nasal BPAP. M-NPPV (but not nasal BPAP) is reported to improve cough effectiveness, an important pulmonary defense in this population.

Description

© 2020 Springer Nature Switzerland AG. Part of Springer Nature.

Locate the Document

https://doi.org/10.1007/s00455-019-09997-6

DOI

10.1007/s00455-019-09997-6

Persistent Identifier

https://archives.pdx.edu/ds/psu/32646

Citation Details

Britton, D., Hoit, J. D., Benditt, J. O., Poon, J., Hansen, M., Baylor, C. R., & Yorkston, K. M. (2020). Swallowing with noninvasive positive-pressure ventilation (NPPV) in individuals with muscular dystrophy: A qualitative analysis. Dysphagia, 35(1), 32-41.