Source: Annual Congress 2003 - Physiology of NIV: understanding the effects and chosing the best settings
Disease area: Respiratory critical care

Abstract

Introduction Non-invasive venilation (NIV) is now widespread in both the acute hospital and domiciliary settings. There is evidence that nasal NIV is associated with mouth leak, particularly during sleep. The aim of this study was to explore the effect of short periods of mouth leak on tidal volume during pressure targetted ventilation.
Methods 11 normal volunteers free of upper respiratory tract congestion and comfortable with NIV were asked to participate. Subjects used the ResMed VPAP in timed mode (rate 15 bpm) with an IPAP of 20cmH₂O and EPAP of 5cmH₂O. Expired tidal volume (Vte) was measured using a pneumotachometer (Hans Rudolph) distal to the exhale valve in the ventilator circuit. After a ten minute acclimitization period subjects were asked to breath through the mouth, to mimic mouth leak during sleep. Mouth leak was continued for 5 minutes, after which subjects closed their mouths and Vte was measured for a further ten minutes.
Results Mean Vte prior to mouth leak was 0.66±0.12 litres. The mean mouth leak was 46l/min.

There is a significant (25%) drop in tidal volume following short periods of mouth leak. The effect on tidal volume continues for up to ten minutes after the cessation of leak.
Conclusion Mouth leak has a major impact on Vt. Adequate humidification should be considered in patients prone to mouth leak during NIV in order to maintain tidal volumes.

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Citations should be made in the following way:
J. M. Tuggey, M. W. Elliott (Leeds, United Kingdom). The effect of mouth leak on tidal volume during non-invasive ventilation. Eur Respir J 2003; 22: Suppl. 45, 1112

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