Respiratory support effect on pharyngeal area in patients with amyotrophic lateral sclerosis: A fluoroscopic comparison of NIV, helmet/CPAP, and high-flow nasal cannula

Alessandra Dorça; José Vergara; Stacey A Skoretz; Michael J Brenner; Denise Sisterolli Diniz; Jorge L Zeredo; Max Sarmet

doi:10.1016/j.rmcr.2023.101958

Respiratory support effect on pharyngeal area in patients with amyotrophic lateral sclerosis: A fluoroscopic comparison of NIV, helmet/CPAP, and high-flow nasal cannula

Respir Med Case Rep. 2023 Dec 10:46:101958. doi: 10.1016/j.rmcr.2023.101958. eCollection 2023.

Authors

Alessandra Dorça¹, José Vergara², Stacey A Skoretz^{3

4

5}, Michael J Brenner⁶, Denise Sisterolli Diniz¹, Jorge L Zeredo⁷, Max Sarmet⁷

Affiliations

¹ Department of Health Sciences, Universidade Federal de Goiás (UFG), Goiânia, Brazil.
² Department of Surgery, University of Campinas, Campinas, Brazil.
³ School of Audiology & Speech Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁴ Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada.
⁵ Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada.
⁶ Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.
⁷ Graduate Department of Health Science and Technology, University of Brasília, Brasília, Brazil.

Abstract

The global use of noninvasive respiratory support provided by different supportive ventilation delivery methods (SVDMs) has increased, but the impact of these devices on the upper airway structures of patients with amyotrophic lateral sclerosis (ALS) is not known. We aimed to compare the pharyngeal cross-sectional area during spontaneous breathing with four different SVDMs: intranasal masks, oronasal masks, high-flow nasal cannula (HFNC), and helmet in patients with ALS. We compared measures of the pharyngeal area during spontaneous breathing and SVDM use. The greatest increase was observed with intranasal mask use, followed by HFNC, oronasal mask, and helmet respectively. In conclusion, upper airway opening in patients with ALS is enhanced by positive pressure with intranasal masks and HFNC, showing promise for increasing pharyngeal patency. Future studies should explore its applicability and effectiveness in maintaining long-term pharyngeal patency, especially in this population with bulbar weakness.

Keywords: Amyotrophic lateral sclerosis; Helmet; High-flow nasal cannula; Neuromuscular diseases; Non-invasive ventilation.

Publication types

Case Reports