Hélène Prigent

Unité Inserm U1077, Caen, Lower Normandy, France

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Publications (55)129.34 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Mechanical insufflation-exsufflation (MI-E), more commonly known as 'cough assist therapy', is a method which produces inspiratory and expiratory assistance to improve cough performances. However, other alternatives or combinations are possible. Objective: The objective was to compare the effects of mechanical insufflation combined with manually assisted coughing (MAC), insufflation-exsufflation alone and insufflation-exsufflation combined with MAC in neuromuscular patients requiring cough assistance. Methods: Eighteen neuromuscular patients with severe respiratory muscle dysfunction and peak cough flow (PCF) lower than 3 liters/s or maximal expiratory pressure (MEP) lower than +45 cm H2O were studied. Patients were studied under three cough-assisted conditions, which were used in random order: insufflation by intermittent positive-pressure breathing (IPPB) combined with MAC, MI-E and MI-E + MAC. Results: Overall, PCF was higher with IPPB + MAC than with MI-E + MAC or MI-E alone. Among the 12 patients who had higher PCF values with IPPB + MAC than with the two other techniques, 9 exhibited mask pressure swings during MI-E exsufflation, with a transient positive-pressure value due to the expiratory flow produced by the combined patient cough effort and MAC. Each of these 9 patients had higher PCF values (>5 liters/s) than did the other 9 patients when using IPPB + MAC. Conclusion: Our results indicate that adding the MI-E device to MAC is unhelpful in patients whose PCF with an insufflation technique and MAC exceeds 5 liters/s. This is because the expiratory flow produced by the patient's effort and MAC transitorily exceeds the vacuum capacity of the MI-E device, which therefore becomes a transient load against the PCF. © 2014 S. Karger AG, Basel.
    08/2014;
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    ABSTRACT: Purpose: We have developed a software that automatically calculates respiratory effort indices, including intrinsic end expiratory pressure (PEEPi) and esophageal pressure-time product (PTPeso). The aim of this study was to validate this software. Materials and Methods: The software first identifies respiratory periods. Then, pressure or flow waveforms with artifacts are automatically excluded from analyses. Clean signals are averaged to provide a reference mean cycle from which respiratory parameters are extracted. The onset of the inspiratory effort is detected automatically by looking backward from the onset of inspiratory flow to the first point where the esophageal pressure derivative is equal to zero (inflection point). PEEPi is derived from this point. Twenty-three recordings from 16 patients were analyzed with the algorithm and compared with experts' manual analysis of signals: 15 recordings were performed during spontaneous breathing, 1 during non-invasive mechanical ventilation, and 7 under both conditions. Results: For all values, the coefficients of determinations (r2) exceeded 0.94 (p<0.001). The bias (mean difference) between PEEPi calculated by hand and automatically was -0.26 ± 0.52 cmH2O during spontaneous breathing and the precisions (standard deviations of the differences) was 0.52 cmH2O with limits of agreement of 0.78 and -1.30 cmH2O. The mean difference between PTPeso calculated by hand and automatically was -0.38 ± 1.42 cmH2O.sec/cycle with limits of agreement of 2.46 and -3.22 cmH2O.sec/cycle. Conclusions: Our program provides a reliable method for the automatic calculation of PEEPi and respiratory effort indices, which may facilitate the use of these variables in clinical practice. The software is open source and can be improved with the development and validation of new respiratory parameters.
    Respiratory Physiology & Neurobiology 01/2014; · 2.05 Impact Factor
  • D. Orlikowski, H. Prigent
    Revue des Maladies Respiratoires Actualites 01/2014; 6(1):13–17.
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    ABSTRACT: We have developed a software that automatically calculates respiratory effort indices, including intrinsic end expiratory pressure (PEEPi) and esophageal pressure-time product (PTPeso). The aim of this study was to validate this software. The software first identifies respiratory periods. Then, pressure or flow waveforms with artifacts are automatically excluded from analyses. Clean signals are averaged to provide a reference mean cycle from which respiratory parameters are extracted. The onset of the inspiratory effort is detected automatically by looking backward from the onset of inspiratory flow to the first point where the esophageal pressure derivative is equal to zero (inflection point). PEEPi is derived from this point. Twenty-three recordings from 16 patients were analyzed with the algorithm and compared with experts' manual analysis of signals: 15 recordings were performed during spontaneous breathing, 1 during non-invasive mechanical ventilation, and 7 under both conditions. For all values, the coefficients of determinations (r(2)) exceeded 0.94 (p<0.001). The bias (mean difference) between PEEPi calculated by hand and automatically was -0.26±0.52 cmH2O during spontaneous breathing and the precisions (standard deviations of the differences) was 0.52 cmH2O with limits of agreement of 0.78 and -1.30 cmH2O. The mean difference between PTPeso calculated by hand and automatically was -0.38±1.42 cmH2O.sec/cycle with limits of agreement of 2.46 and -3.22 cmH2O.sec/cycle. Our program provides a reliable method for the automatic calculation of PEEPi and respiratory effort indices, which may facilitate the use of these variables in clinical practice. The software is open source and can be improved with the development and validation of new respiratory parameters.
    Respiratory Physiology & Neurobiology 12/2013; · 2.05 Impact Factor
  • Article: Response.
    Chest 11/2013; 144(5):1740-1. · 5.85 Impact Factor
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    ABSTRACT: Battery life (BL) of portable home ventilators batteries are reported by manufacturers. The aim of the study was to evaluate the effects of ventilatory mode, respiratory frequency, positive end-expiratory pressure (PEEP), and leaks on the BL of 5 commercially available portable ventilators. The effect of the ventilatory mode (volume controlled-continuous mandatory ventilation [VC-CMV] vs Pressure Support ventilation [PS]), PEEP 5 cmH2O, respiratory frequency (10, 15 and 20 cycles/min), and leaks during both VTV and PS on the BL of5 ventilators (Elisee 150, Monnal T50, PB 560, Vivo 50, and Trilogy 100) were evaluated. Each ventilator was ventilated with a test lung at a tidal volume of 700 ml and an inspiratory time 1.2 in the absence of leaks. The switch of a VC-CMV mode for a PS mode or the addition of PEEP did not significantly change the ventilator BL. The increase of the respiratory frequency from 10 to 20 cycles/min decreased the BL of 18 ± 11% (P<0.005). Leaks were associated with an increase of the BL during the VC-CMV mode (18 ± 20%, P<0.05) whereas the BL decreased during the PS mode (-13 ± 15%, P<0.05). The BL of home ventilators depends on the ventilatory settings. The BL is not affected by the ventilator mode (VC-CMV or PS) or the addition of PEEP. BL decreases with the increase in respiratory frequency and during leaks with a PS mode whereas leaks increase the duration of the ventilator BL during VC-CMV.
    Respiratory care. 10/2013;
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    ABSTRACT: BACKGROUND: To maximise the likelihood of successful long term mechanical ventilation (MV) in patients with neuromuscular diseases, ventilators characteristics and settings must be chosen carefully taking into account both medical requisites and the patient's preference and comfort. The general objectives of the survey were 1) to evaluate patients comfort with, and knowledge about, their long term MV; 2) to compare patients and prescribers opinions and expectations regarding long term MV; 3) to compare the equipment used by the patients with prescribers present opinion. METHODS: Neuromuscular patients receiving long term MV and home MV prescribers in Belgium and France and MV prescribers were asked to respond to a questionnaire survey specifically developed for the study. RESULTS: Completed questionnaires were collected from 209 patients, mean age 35.4±15.9 years (range 3 to 86 years), ventilated since 11 ± 17 year, and 45 MV prescribers. Hundred sixty three (78%) patients correctly designed their MV mode as a volume or a pressure targeted mode and 86% considered their MV as "efficient". When an inspiratory trigger was available, 92% of the patients were able to use it but only 72% were satisfied. Prescribers were more prone than patients to use new technologies, such as an emergency system to release a noninvasive interface (visual analogue scale (VAS/10): 9.2±1.5 vs 6.8±3.3, P=0.0001), a humidification system (VAS: 8.6±1.4 vs 7.8±2.6, P=0.02), a contactor for providing larger inspiratory volumes (VAS: 8.4±1.7 vs 6.0±3.0, P=0.009), an in-built cough assistance mode (VAS: 9.2±1.4 vs 5.5±3.3 P=0.00001), new options to improve speech, or new MV modes such as a volume targeted-pressure controlled mode. CONCLUSIONS: Patient's and prescriber's opinion differ about the ideal home ventilator. Patients are less prone to use new technologies, mainly because of a lack of information, underlining the need of regular MV update in patients receiving long term MV.
    Respiratory care. 06/2013;
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    ABSTRACT: OBJECTIVE: Communication is a major issue for patients with tracheostomy who are supported by mechanical ventilation. The use of positive end-expiratory pressure (PEEP) may restore speech during expiration; however, the optimal PEEP level for speech may vary individually. We aimed to improve speech quality with an individually adjusted PEEP level delivered under the patient's control to ensure optimal respiratory comfort. METHODS: Optimal PEEP level (PEEPeff), defined as the PEEP level that allows complete expiration through the upper airways, was determined for 12 patients with neuromuscular disease who are supported by mechanical ventilation. Speech and respiratory parameters were studied without PEEP, with PEEPeff, and for an intermediate PEEP level. Flow and airway pressure were measured. Microphone speech recordings were subjected to both quantitative and qualitative assessments of speech, including an intelligibility score, a perceptual score, and an evaluation of prosody determined by two speech therapists blinded to PEEP condition. RESULTS: Text reading time, phonation flow, use of the respiratory cycle for phonation, and speech comfort significantly improved with increasing PEEP, whereas qualitative parameters remained unchanged. This resulted mostly from the increase of the expiratory volume through the upper airways available for speech for all patients combined, with a rise in respiratory rate for nine patients. Respiratory comfort remained stable despite high levels of PEEPeff (median, 10.0 cm H2O; interquartile range, 9.5-12.0 cm H2O). CONCLUSIONS: Patient-controlled PEEP allowed for the use of high levels of PEEP with good respiratory tolerance and significant improvement in speech (enabling phonation during the entire respiratory cycle in most patients). The device studied could be implemented in home ventilators to improve speech and, therefore, autonomy of patients with tracheostomy. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01479959; URL: clinicaltrials.gov.
    Chest 05/2013; 143(5):1243-1251. · 5.85 Impact Factor
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    Jonathan LEVY, Hélène PRIGENT, David ORLIKOWSKI
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    ABSTRACT: L’appareillage par des techniques de ventilation à domicile (VAD) constitue un élément clé de la prise en charge des maladies neuromusculaires (MNM). Les techniques de rééducation respiratoire sont bien souvent un adjuvant indispensable pour une efficacité optimale de la VAD. La mise en place de la VAD doit être encadrée par des équipes hospitalières habituées et formées à l’exploration, au traitement et au suivi de la pathologie respiratoire des MNM. Le relais avec l’équipe de ville suivant le patient au quotidien est une étape essentielle à la bonne réalisation de la VAD.
    Les cahiers de myologie. 04/2013;
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    ABSTRACT: ABSTRACT BACKGROUND: The objective was to determine whether optoelectronic plethysmography (OEP) can detect asymmetrical ventilation related to unilateral or asymmetrical diaphragmatic weakness, suggesting usefulness as a diagnostic tool. PATIENTS AND METHODS: 13 patients with suspected asymmetrical diaphragmatic weakness based on dyspnea and hemidiaphragm elevation on the chest radiograph were studied, as well as 3 patients with maltase acid deficiency (a cause of symmetrical diaphragmatic weakness). The transdiaphragmatic pressure response to unilateral magnetic stimulation (latPdiTw) and the diaphragm compound muscle action potentials (CMAPs) elicited by transcutaneous electrical stimulation of each phrenic nerve as well as OEP were performed. RESULTS: The CMAPs and latPdiTw showed unilateral or predominantly unilateral diaphragmatic weakness in 9 of the 13 patients. By OEP, the affected side of the thorax and abdomen contributed less than 45% of the inspiratory capacity in each of these 9 patients, whereas no asymmetry was noted in the other 4 patients or in the 3 patients with maltase acid deficiency. All patients preferred OEP over CMAP or latPdiTw. CONCLUSION: OEP detected asymmetric ventilation in all patients diagnosed with unilateral diaphragm weakness and in no patients without this diagnosis. Thus, OEP is an effective noninvasive alternative that is preferred by the patients over CMAP response and latPdiTw.
    Chest 03/2013; · 5.85 Impact Factor
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    ABSTRACT: BACKGROUND: To determine whether optoelectronic plethysmography accurately evaluated vital capacity (VC) in patients with respiratory muscle dysfunction of variable severity, including those with paradoxical abdominal movements. METHODS: In 20 patients, VC was measured in the supine position using both spirometry and optoelectronic plethysmography (six optoelectronic cameras and 52 reflective markers on the anterior chest wall). RESULTS: Spirometry VC correlated positively with optoelectronic VC (r²=0.993, p<0.0001) and the regression line was very close to the identity line (VCopto (mL) =-1.202 + 1.007*VCspiro (mL)). A Bland and Altman plot showed that the mean difference was -20 mL (95%CI: -63 mL to 24 mL) and the limits of agreement were 163 mL (95%CI: 106 mL to 231 mL) and -203 mL (95% CI: -271 mL to -146 mL). The difference between the two values expressed as the percentage of the mean value was less than 15% in all 20 participants, less than 10% in 17 (85%) participants, and less than 5% in 11 (55%) participants. The difference expressed as the percentage of the mean value was unrelated to the contribution of abdominal motion to VC (r =0.02 and p=0.94) but was significantly related to body mass index (r=0.53, p=0.015). CONCLUSIONS: Optoelectronic plethysmography is accurate and suitable for VC measurement in patients with various degrees of respiratory failure, including those with paradoxical abdominal movements. This non-invasive method may be an attractive alternative for accurately measuring VC in the event of air leakage (through the mouth or tracheostomy) or when patients are unable to breathe with the dead space added by the spirometer.
    Respiratory care 08/2012; · 2.03 Impact Factor
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    ABSTRACT: Inspiratory unintentional leaks (IULs) during noninvasive ventilation (NIV) adversely affect the sleep and the effectiveness of mechanical ventilation (MV). The aim of this study was to assess the effects of nocturnal IULs in Duchenne muscular dystrophy (DMD) patients with a tracheostomy and uncuffed tube comparatively with NIV patients. Polysomnography with transcutaneous partial pressure of carbon dioxide (PtcCO(2)) recording and blood gas measurement was performed in 26 stable tracheostomized DMD patients using home MV, among whom 11 were matched with NIV patients. IULs occurred during 29.4% [1.7-61.9%] (median [IQR]) of the total sleep time. By univariate regression analysis, the closest correlation with IUL duration was for daytime base excess (r(2)=0.69, P<0.0001), followed by daytime bicarbonate level. In a stepwise multiple regression analysis, only base excess remained significantly correlated. Sleep and respiratory parameters improved in the four patients who agreed to use cuffed tubes. Tracheostomized patients had lower maximal PtcCO(2) (P=0.02) and base excess values (P=0.045) compared to NIV controls. Tracheostomy does not guarantee that MV is effective during sleep, as IULs may occur, but ensures better nocturnal gas exchanges than NIV. DMD patients should be evaluated using at least blood gas measurement, nocturnal oximetry, and PtcCO(2) monitoring.
    Sleep Medicine 07/2012; 13(8):1056-65. · 3.49 Impact Factor
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    ABSTRACT: Amyotrophic lateral sclerosis (ALS) is a fast course neuromuscular disease. One of the main specificities of this disease is the few number of ventilated patients whereas the benefit of this treatment has been demontrated. Furthermore, the recommendations exist but are not applied and the care is not enough anticipated. The improvement relate to the networks between city and hospital and the research.
    Revue des Maladies Respiratoires Actualites 07/2012; 4(3):187–189.
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    ABSTRACT: Myotonic Dystrophy Type 1 (DM1) is the most common autosomal dominant muscular dystrophy worldwide. The cognitive defects and cardiac arrrthymias are usual. The respiratory drive is frequently abnormal with hypercapnia, hypersomnia and sleep apnea (obstructive or central). At present, therapy addresses correcting hormonal and glycemic balance, removing cataract, preventing respiratory failure and, above all, major cardiac disturbances. The respiratory management aims to normalize PaCO2 and sleep disturbances and to prevent cardiac arrrthymias. Implement non invasive ventilation is complex in this situation with cognitive deficits. The observance is low, perhaps owing to the misunderstanding and because of the lack of perceived benefit in terms of quality of life or hypersomnia.
    Revue des Maladies Respiratoires Actualites 07/2012; 4(3):190–193.
  • A. Cuvelier, H. Prigent, H. Le Floch
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    ABSTRACT: Ventilation improvements have led to an increased number of ventilator-dependent neuromuscular patients. In order to ensure adequate ventilation efficiency and security while maintaining quality of life, the check-list is large. Two « life support » ventilators are mandatory, while different interfaces may be required for nighttime and daytime ventilation, in order to maintain communication. Airways clearance is a major goal. It requires physiotherapists, cough assistance devices and the participation of the relatives. The decision of tracheostomy needs to be individually evaluated. Permanent anticipation is necessary.
    Revue des Maladies Respiratoires Actualites 07/2012; 4(3):194–198.
  • Revue des Maladies Respiratoires Actualites 07/2012; 4(3):204–207.
  • European Respiratory Journal 06/2012; 39(6):1545-6. · 6.36 Impact Factor
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    ABSTRACT: Pulse oximetry alone has been suggested to determine which patients on home mechanical ventilation (MV) require further investigation of nocturnal gas exchange. In patients with neuromuscular diseases, alveolar hypoventilation (AH) is rarely accompanied with ventilation-perfusion ratio heterogeneity, and, therefore, oximetry may be less sensitive for detecting AH than in patients with lung disease. To determine whether pulse oximetry (S(pO(2))) and transcutaneous carbon dioxide (P(tcCO(2))) during the same night were interchangeable or complementary for assessing home MV efficiency in patients with neuromuscular diseases. Data were collected retrospectively from the charts of 58 patients with chronic neuromuscular respiratory failure receiving follow-up at a home MV unit. S(pO(2)) and P(tcCO(2)) were recorded during a 1-night hospital stay as part of standard patient care. We compared AH detection rates by P(tcCO(2)), S(pO(2)), and both. AH was detected based on P(tcCO(2)) alone in 24 (41%) patients, and based on S(pO(2)) alone with 3 different cutoffs in 3 (5%), 8 (14%), and 13 (22%) patients, respectively. Using both P(tcCO(2)) and S(pO(2)) showed AH in 25 (43%) patients. Pulse oximetry alone is not sufficient to exclude AH when assessing home MV efficiency in patients with neuromuscular diseases. Both P(tcCO(2)) and S(pO(2)) should be recorded overnight as the first-line investigation in this population.
    Respiratory care 02/2012; 57(9):1425-30. · 2.03 Impact Factor
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    01/2012; , ISBN: 978-953-307-793-2

Publication Stats

293 Citations
129.34 Total Impact Points

Institutions

  • 2014
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2004–2013
    • Université de Versailles Saint-Quentin
      Versailles, Île-de-France, France
  • 2012
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 2004–2012
    • Hôpital Raymond-Poincaré – Hôpitaux universitaires Paris Ile-de-France Ouest
      Île-de-France, France
  • 2010
    • Centre Hospitalier Universitaire de Caen
      • Unité Réanimation Médicale
      Caen, Basse-Normandie, France
  • 2005
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France