Influence of the cuff pressure on the swallowing reflex in tracheostomized intensive care unit patients R. Amathieu, S. Sauvat, P. Reynaud, V. Slavov,

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Influence of the cuff pressure on the swallowing reflex in tracheostomized intensive care unit patients R. Amathieu, S. Sauvat, P. Reynaud, V. Slavov, D. Luis, A. Dinca, L. Tual, S. Bloc, G. Dhonneur British Journal of Anaesthesia Volume 109, Issue 4, Pages 578-583 (October 2012) DOI: 10.1093/bja/aes210 Copyright © 2012 The Author(s) Terms and Conditions

Fig 1 Schematic illustration of the method used to evaluate the influence of CP increase on the swallowing reflex in tracheostomized patients. EMG and laryngeal acceleration (LA) were measured during reflexively elicited swallows at different values of CP measured using a CP controller (CPC). A pneumotachograph and a differential pressure transducer (PnT) were used to synchronize hypopharyngeal stimulations with the end-expiratory phase. A double-piston syringe (DPS) was used to simultaneously inject the pharyngeal stimulus (predefined: 0.3–5 ml volume, cold 3°C, distilled water bolus), and flush 1 ml of air within the ventilatory circuit. British Journal of Anaesthesia 2012 109, 578-583DOI: (10.1093/bja/aes210) Copyright © 2012 The Author(s) Terms and Conditions

Fig 2 Typical recording from one patient showing the characteristics of the swallowing reflex. EMG, electromyography; LA, laryngeal acceleration. The peak EMG (EMGp) and ALA were measured. For each reflexively elicited swallow, EMGp and ALA were computed. Reflex swallows were elicited during the end-expiratory phase using a continuous ventilatory flow monitoring. The latency time (LaT) of the swallowing reflex was calculated as the time elapsing between the onset of the pharyngeal stimulation artifact (respiratory flow trace) and that of the integrated EMG signal. British Journal of Anaesthesia 2012 109, 578-583DOI: (10.1093/bja/aes210) Copyright © 2012 The Author(s) Terms and Conditions

Fig 3 Influence of CP (cm H2O) increase on the latency times of the swallowing reflex expressed in the percentage of control measures. Values are means (blue diamonds) and sd (vertical bars), *P<0.05 when compared with control values. British Journal of Anaesthesia 2012 109, 578-583DOI: (10.1093/bja/aes210) Copyright © 2012 The Author(s) Terms and Conditions

Fig 4 Influence of CP (cm H2O) increase on swallowing-induced laryngeal elevation accelerometry amplitude (ALA) expressed as the percentage of control values. Values are means (blue diamonds) and sd (vertical bars). *P<0.05 when compared with control values. British Journal of Anaesthesia 2012 109, 578-583DOI: (10.1093/bja/aes210) Copyright © 2012 The Author(s) Terms and Conditions

Fig 5 Influence of CP (cm H2O) increase on the integrated peak electromyography (EMGp) of the submental swallowing muscles expressed as the percentage of control measures. Values are means (blue diamonds) and sd (vertical bars). *P<0.05 when compared with control values. British Journal of Anaesthesia 2012 109, 578-583DOI: (10.1093/bja/aes210) Copyright © 2012 The Author(s) Terms and Conditions