Comparison of SIMV+PS and AC modes in chronically ventilated children and effects on speechg.

BACKGROUND: Two modes of ventilation commonly used in children requiring chronic home mechanical ventilation (HMV) via tracheostomy are Assist Control (AC) and Synchronized Intermittent Mandatory Ventilation with Pressure Support (SIMV+PS). There has been no study comparing these two modes of ventilation in children requiring chronic HMV. METHODS: We studied children requiring HMV capable of completing speech testing. Study participants were blinded to changes and studied on both modes, evaluating their oxygen saturation, end tidal carbon dioxide (PET CO2 ), heart rate, respiratory rate, and respiratory pattern. Subjects completed speech testing and answered subjective questions about their level of comfort, ease of breathing, and ease of speech. RESULTS: Fifteen children aged 12.3±4.8 years were tested. There was no difference in mean oxygen saturation, minimum oxygen saturation, mean PET CO2 , maximum PET CO2 , mean heart rate, and mean respiratory rate. The maximum heart rate on AC was significantly lower than SIMV+PS, p=0.047. Subjects breathed significantly above the set rate on SIMV+PS (p=0.029), though not on AC. Subjects found it significantly easier to speak on AC, though there was no statistically significant difference in speech testing. Four subjects had multiple prolonged PS breaths on SIMV+PS. Many subjects exhibited an abnormal cadence to speech, with some speaking during both inhalation and exhalation phases of breathing. CONCLUSIONS: There were few differences between AC and SIMV+PS, with a few parameters favoring AC that may not be clinically significant. This includes subjective perception of ease of speech. We also found unnatural patterns of speech in children requiring HMV. This article is protected by copyright. All rights reserved.

Comparison of SIMV + PS and AC modes in chronically ventilated children and effects on speech.

BACKGROUND: Two modes of ventilation commonly used in children requiring chronic home mechanical ventilation (HMV) via tracheostomy are Assist Control (AC) and Synchronized Intermittent Mandatory Ventilation with Pressure Support (SIMV + PS). There has been no study comparing these two modes of ventilation in children requiring chronic HMV. METHODS: We studied children requiring HMV capable of completing speech testing. Study participants were blinded to changes and studied on both modes, evaluating their oxygen saturation, end-tidal carbon dioxide (PETCO2), heart rate, respiratory rate, and respiratory pattern. Subjects completed speech testing and answered subjective questions about their level of comfort, ease of breathing, and ease of speech. RESULTS: Fifteen children aged 12.3 ± 4.8 years were tested. There was no difference in mean oxygen saturation, minimum oxygen saturation, mean PETCO2, maximum PETCO2, mean heart rate, and mean respiratory rate. The maximum heart rate on AC was significantly lower than SIMV + PS, p = .047. Subjects breathed significantly above the set rate on SIMV + PS (p = .029), though not on AC. Subjects found it significantly easier to speak on AC, though there was no statistically significant difference in speech testing. Four subjects had multiple prolonged PS breaths on SIMV + PS. Many subjects exhibited an abnormal cadence to speech, with some speaking during both inhalation and exhalation phases of breathing. CONCLUSIONS: There were few differences between AC and SIMV + PS, with a few parameters favoring AC that may not be clinically significant. This includes the subjective perception of ease of speech. We also found unnatural patterns of speech in children requiring HMV.

Factors impacting participation in flexible endoscopic evaluation of swallowing in children.

OBJECTIVES: Flexible endoscopic evaluation of swallowing (FEES) is a common and useful tool for assessment of dysphagia and swallowing safety in children, however an important problem is limited participation in some children. We examine the factors associated with adequate participation in children undergoing FEES, including the completion rate, whether a clear diagnosis or feeding plan was made, and the incidence of adverse events (AEs). METHODS: We conducted a retrospective review of children undergoing FEES at an urban children's hospital. Data collected included age, gender, race, comorbidities, AEs and outcomes of FEES. RESULTS: Of the 130 patients, 46 (35%) were female with a median age of 2.6 years. 113 (87%) patients cooperated and obtained a result, while 15 (12%) patients did not cooperate and no result was obtained; there was no significant difference in gender, comorbidities, or race between those groups. The age distribution of FEES subjects in this study was skewed with nearly 75% below age 5. Patients who cooperated had a higher median age (3 years) than those who did not (1.2 years) and 47% of non-cooperators were less than 1 year of age. There were no significant AEs, the most common mild AE was excessive crying (34 subjects, 26%). In a multivariate model controlling for age and gender, excessive crying was associated with a decreased odds of cooperation (OR: 0.16, p = 0.004, 95% CI: 0.04, 0.54). CONCLUSION: Children who undergo FEES have an overall favorable completion rate and no serious adverse events, however its utility is limited in cases where children refuse to participate. Understanding the factors associated with failure to cooperate with FEES is important in developing strategies to improve participation. Excessive crying is identified as such a factor in this study.