Michel ToussaintUniversité Libre de Bruxelles | ULB · Service de Neurologie
Michel Toussaint
PhD
Coordination Centre for Home Mechanical Ventilation, Centre for Neuromuscular Disorders, Erasme Hospital, Brussels, BEL
About
69
Publications
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1,466
Citations
Citations since 2017
Introduction
Publications
Publications (69)
Aim:
To (1) compare the perceived benefit of long-term mechanical insufflation-exsufflation (MI-E) of children with neuromuscular disorders (NMDs) and central nervous system (CNS) disorders, including health care needs and treatment routines and (2) describe the children's health-related quality of life (HRQoL).
Method:
This cross-sectional stud...
Home mechanical ventilation (HMV) improves quality of life and survival in patients with neuromuscular disorders (NMD). Developing countries may benefit from published evidence regarding the prevalence, cost of equipment, technical issues and organisation of HMV in NMD, facilitating the development of local turn-key HMV programmes. Unfortunately, s...
Dysphagia is common in patients with neuromuscular diseases (NMDs). Its management differs by country and clinical setting. The purpose of this study was to describe current practices in the management of dysphagia in NMDs across Europe. An online survey of sixteen questions was developed, including basic information on facilities, existence of a m...
Objective:
To evaluate the effects and safety of exercise training, and to determine the most effective exercise intervention for people with Duchenne muscular dystrophy. Exercise training was compared with no training, placebo or alternative exercise training. Primary outcomes were functioning and health-related quality of life. Secondary outcome...
Introduction/aims:
Oropharyngeal dysphagia is common in patients with neuromuscular diseases (NMDs). Its early recognition is vital for proper management. We tested a large cohort of adult NMD patients for oropharyngeal dysphagia using the Sydney Swallow Questionnaire (SSQ). We also looked for possible differences in characteristics of oropharynge...
Background:
People with neuromuscular disorders may have a weak, ineffective cough predisposing them to respiratory complications. Cough augmentation techniques aim to improve cough effectiveness and mucous clearance, reduce the frequency and duration of respiratory infections requiring hospital admission, and improve quality of life.
Objectives:...
In neuromuscular disorders (NMDs), nocturnal non-invasive ventilation (NIV) via a nasal mask is offered when hypercapnic respiratory failure occurs. With disease progression, nocturnal NIV needs to be extended into the daytime. Mouthpiece ventilation (MPV) is an option for daytime NIV. MPV represents a difficult task for home ventilators due to rap...
Objective: To assess the quality of SpO2 and PCO2 recordings via transcutaneous monitoring in children with neurological conditions.
Methods: Overnight transcutaneous SpO2 and PCO2 were analyzed. The presence of drift and drift correction was noted, and the rate of disrupted recordings scored (0: absence, 1; presence). The quality of recordings was...
Aim
To determine the prevalence of long‐term mechanical insufflation‐exsufflation (MI‐E) and concomitant mechanical ventilation in children with neurological conditions, with reported reasons behind the initiation of treatment.
Method
This was a population‐based, cross‐sectional study using Norwegian national registries and a questionnaire.
Resul...
Background:
Late-onset Pompe disease (LOPD) is a rare, hereditary, progressive disorder that is usually characterized by limb-girdle muscle weakness and/or respiratory insufficiency. LOPD is caused by mutations in the acid alpha-glucosidase (GAA) gene and treated with enzyme replacement therapy (ERT).
Methods:
We studied the clinical, brain imag...
Title: La ventilation par embout buccal dans les maladies neuromusculaires.
Abstract: Le document qui suit est la traduction intégrale du compte rendu établi à l’occasion du 252e atelier international ENMC consacré, du 6 ou 8 mars 2020, au « Développement de recommandations pour l’utilisation de la ventilation par embout buccal dans les maladies ne...
Background:
Carbon dioxide tension (PCO2) monitoring during sleep, is crucial to identify respiratory failure in patients with neuromuscular disorders (NMD). Transcutaneous PCO2 monitoring is an available technique to measure PCO2.
Objectives:
To assess the quality level of transcutaneous blood gas measurements via SenTec monitor.
Methods:
A 1...
Mechanical insufflation-exsufflation (MI-E) is recommended for subjects of all ages with neuromuscular disorders (NMDs) and weak cough. There is a lack of knowledge on the optimal treatment settings for young children. This study aims to determine the MI-E settings providing high expiratory airflow while using safe inspiratory volumes, and to ident...
Background:
Patients with neuromuscular disorders (NMDs) are likely to develop respiratory failure which requires noninvasive ventilation (NIV). Ventilation via a mouthpiece (MPV) is an option to offer daytime NIV.
Objectives:
To determine the preferred equipment for MPV by patients with NMDs.
Methods:
Two MPV equipment sets were compared in 2...
Oropharyngeal dysphagia is frequently under-reported and early detection may lead to adapt strategies of rehabilitation and management decisions. The Sydney Swallow Questionnaire (SSQ), a self-reported questionnaire for the detection and quantification of oropharyngeal dysphagia, was previously adapted and validated in other languages but not in Fr...
Background
The purpose of this systematic review was to summarize the different dysphagia screening and evaluation tools, and to identify their measurement properties in adults with neuromuscular diseases (NMDs).
Methods
A systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guide...
Supplement_1 – Supplemental material for Screening and evaluation tools of dysphagia in adults with neuromuscular diseases: a systematic review
Supplement_2 – Supplemental material for Screening and evaluation tools of dysphagia in adults with neuromuscular diseases: a systematic review
Respiratory problems have a significant impact on morbidity and mortality in patients with cerebral palsy (CP). In particular, recurrent aspiration, impaired airway clearance, spinal and thoracic deformity, impaired lung function, poor nutritional status, and recurrent respiratory infections negatively affect respiratory status. Bronchopulmonary dy...
This is a unique state of the art review written by a group of 21 international recognized experts in the field that gathered during a meeting organized by the European Neuromuscular Centre (ENMC) in Naarden, March 2017. It systematically reports the entire evidence base for airway clearance techniques (ACTs) in both adults and children with neurom...
Mechanical insufflation-exsufflation (MI-E) is a strategy to treat pulmonary exacerbations in neuromuscular disorders (NMDs). Pediatric guidelines for optimal setting titration of MI-E are lacking and the settings used in studies vary. Our objective was to assess the actual MI-E settings being used in current clinical treatment of children with NMD...
Aim:
Dysphagia is frequent in paediatric patients with neuromuscular diseases (pNMD). Its detection is important for initiating early diagnosis and treatment as well as for minimizing related complications. The aim of this study was to review the literature on dysphagia screening and evaluation tools in pNMD.
Method:
A systematic review was perf...
Purpose:
Duchenne muscular dystrophy (DMD) is a rapidly progressive neuromuscular disorder causing weakness of the skeletal, respiratory, cardiac and oropharyngeal muscles with up to one third of young men reporting difficulty swallowing (dysphagia). Recent studies on dysphagia in DMD clarify the pathophysiology of swallowing disorders and offer n...
Home mechanical ventilation has become a standard of care to effectively treat chronic respiratory failure, both in patients with restrictive diseases such as neuromuscular and thorax cage disorders and in patients with obstructive diseases such as selected cases of lung and airways disorders. Depending on the group of patients, home ventilation ma...
Background:
Air stacking improves cough effectiveness in people with Duchenne muscular dystrophy (DMD) and respiratory muscle weakness. However, it is not known whether air stacking is more effective via a resuscitator bag or a home ventilator.
Methods:
This prospective randomized study investigated the effect of air stacking via a volume-cycled...
Children with severe central neurological disorder (cerebral palsy, the multihandicapped) suffer from impaired coordination of their respiratory muscles. The relative immobility of these patients, the chest deformities and the risk of epilepsy and gastroesophageal reflux can lead to disorders of ventilation/perfusion and to difficult swallowing. Th...
Background:
Neuroplastic compensations are reported to improve static balance in visually impaired people (VIP).
Objective:
To compare the static balance of VIP with control sighted subjects in different conditions of proprioceptive disturbance.
Methods:
Thanks to a stabilometric platform, static balance was determined by measuring (1) the spe...
Background:
Daytime mouthpiece ventilation is a useful adjunct to nocturnal noninvasive ventilation (NIV) in patients with neuromuscular disease. The aims of the study were to analyze the practice of mouthpiece ventilation and to evaluate the performance of ventilators for mouthpiece ventilation.
Methods:
Practice of mouthpiece ventilation was a...
Background:
To maximize the likelihood of successful long-term mechanical ventilation (MV) in patients with neuromuscular diseases, ventilator characteristics and settings must be chosen carefully, taking into account both medical requisites and the patient's preference and comfort.
Objectives:
To evaluate patients' knowledge about and comfort w...
Intrapulmonary Percussive Ventilation (IPV) is used to treat peripheral airway obstruction as well as disorders of ventilation.
The medical literature shows that IPV can be deployed for both symptomatic and prophylactic purposes. When conventional techniques of chest physiotherapy have been ineffective, IPV may be delivered in a variety of severe r...
Intrapulmonary Percussion Ventilation (IPV) was designed to promote airway clearance, to recruit areas of lung and to improve pulmonary gas exchange. Its principle is to administer bursts of small tidal volume at high frequency. This article describes IPV devices, especially the Phasitron(®), which provides a dynamic interface between the pneumatic...
Intrapulmonary Percussion Ventilation (IPV) was designed to promote airway clearance, to recruit areas of lung and to improve pulmonary gas exchange. Its principle is to administer bursts of small tidal volume at high frequency. This article describes IPV devices, especially the Phasitron®, which provides a dynamic interface between the pneumatic s...
BACKGROUND: Daytime mouthpiece ventilation is a useful adjunct to nocturnal noninvasive ventilation (NIV) in patients with neuromuscular disease. The aims of the study were to analyze the practice of mouthpiece ventilation and to evaluate the performance of ventilators for mouthpiece ventilation. METHODS: Practice of mouthpiece ventilation was asse...
In molte patologie cardiorespiratorie, la capacità fisica e la tolleranza allo sforzo sono regolarmente ridotte. Secondo le situazioni, possono essere valutate per mezzo di prove da sforzo effettuate in laboratorio o con test di terreno. I test di deambulazione sono interessanti per un follow-up regolare e sono facilmente realizzabili nella pratica...
Las enfermedades cardiorrespiratorias en las que la capacidad física y la tolerancia al esfuerzo están disminuidas son numerosas. Estos dos parámetros pueden evaluarse mediante pruebas de esfuerzo que, según las situaciones, se realizan en el laboratorio o sobre el terreno. Las pruebas de marcha son útiles para el control de rutina y fáciles de hac...
Despite potential benefits of intrapulmonary percussive ventilation (IPV) in various respiratory diseases, the impact of setting parameters on the mechanical effects produced by IPV in the lungs is unknown. We hypothesized that changing the parameters on IPV would modulate these effects. This in vitro study aimed at comparing the changes in intrapu...
L’utilité de la ventilation à percussions intrapulmonaires (IPV) en réanimation fait l’objet de controverses en raison du manque de preuves scientifiques quant à ses principes d’action et à ses bénéfices thérapeutiques. L’impact de l’IPV rapporté dans la littérature médicale concerne l’amélioration du drainage bronchique, le recrutement de territoi...
During the past 20 years, airway clearance techniques have been the subject of increasing scientific interest. Cough augmentation with mechanical insufflation-exsufflation is part of this trend. No fewer than 23 studies, of which 21 were published in the past 10 years, have improved the level of
Home mechanical ventilation requires equipment, consisting of a generator of pressure, a tubing and an interface to deliver air to the patient. Instructions for equipment maintenance are generally not based on scientific evidence. Studies however have reported that tubing and masks used at home are the most commonly found as very dirty and contamin...
Home mechanical ventilation requires equipment, consisting of a generator of pressure, a tubing and an interface to deliver air to the patient. Instructions for equipment maintenance are generally not based on scientific evidence. Studies however have reported that tubing and masks used at home are the most commonly found as very dirty and contamin...
8 8.1 Introduction Home mechanical ventilation has become a standard of care to effectively treat chronic respira-tory failure either in patients with restrictive diseases such as neuromuscular and thorax cage disorders or in patients with obstructive diseases such as selected cases of lung and airway dis-orders. Depending on the group of patients,...
Van den Eynde D., Reychler G., Troosters T., Toussaint M.
Manual and mechanical cough-augmentation techniques can improve peak cough flow (PCF) in patients with respiratory insufficiency caused by neuromuscular disease.
We studied cough-augmentation techniques in 179 clinically stable patients with various neuromuscular diseases. We measured vital capacity (VC), maximum expiratory pressure (MEP), and PCF,...
Patients affected by restrictive respiratory insufficiency typically present with cough impairment due to respiratory muscle weakness. Beside manual cough augmentation therapies such as hyperinflation and chest compression, mechanical devices such as Mechanical Insufflation-Exsufflation (MI-E) were developed to amplify peak cough flows (PCF) in the...
Respiratory muscle weakness in patients with Duchenne muscular dystrophy (DMD) leads to respiratory failure for which non-invasive positive pressure ventilation (NIPPV) is an effective treatment. This is used initially at night (n-NIPPV) but, as the disease progresses, diurnal use (d-NIPPV) is often necessary. The connection between NIPPV and relie...
The aim of this study was to compare morbidity and causes of death in a series of 42 Duchenne patients receiving full-time mechanical ventilation either by tracheostomy (TR, n = 16 or by noninvasive methods (noninvasive ventilation [NIV], n = 26). At inclusion for a 5-year observation period (2002-2006), TR and NIV patients were 32.7 and 27 years o...
Persistent atelectasis in children is lacking a gold standard treatment. Intrapulmonary percussive ventilation (IPV) is presented as a promising chest physiotherapy technique in the treatment of atelectasis. This study aimed to follow the evolution of atelectasis resolution with noninvasive IPV in young children and to detect eventual adverse effec...
In patients with Duchenne muscular dystrophy (DMD), implementation of mechanical ventilation depends on sleep investigation and measurement of CO2 tension. The objective of this cross-sectional study was to determine which noninvasive lung function parameter best predicts nocturnal hypercapnia and diurnal hypercapnia in these patients.
According to...
Chronic respiratory insufficiency is inevitable in the course of disease progression in patients with Duchenne muscular dystrophy (DMD). Without mechanical ventilation (MV), morbidity and mortality are highly likely towards the end of the second decade of life. The present review reports evidence and clinical implications regarding DMD patients tre...
The present study aimed to assess the impact of diurnal mouthpiece intermittent positive pressure ventilation (MIPPV) as the extension of the nasal intermittent positive pressure ventilation (NIPPV) in Duchenne muscular dystrophy (DMD). In total, 42 DMD patients aged 15-33 yrs, normocapnic at night with NIPPV and receiving MIPPV since end-diurnal h...
Home mechanical ventilation is used to treat chronic alveolar hypoventilation. Maintenance protocols for home ventilation circuits (HVC) remain empirical and unproven. We have investigated (1) the cleanliness and sterility of the HVC used by home ventilated patients and (2) the efficiency of tubing cleaning and decontamination protocols recommended...
To determine the effects of intrapulmonary percussive ventilation (IPV) on mucus clearance in tracheostomized Duchenne muscular dystrophy patients.
We studied 8 patients, 5 of whom had mucus hypersecretion (> 30 mL/d). In a randomized, cross-over study we compared assisted mucus clearance techniques with and without IPV. There were 2 treatment sequ...
Projects
Project (1)
Dear colleagues,
As part of my thesis (PhD) on swallowing disorders in patients with neuromuscular patients, we are currently launching an European survey on the management of dysphagia in neuromuscular patients.
if you are concerned about the care of neuromuscular patients, I'm going to ask you if you could complete the survey for your center or transfer to the corresponding persons. Completing the questionnaire will take a maximum of five minutes.
Through 12 questions, the objective of this survey is to better understand practices in the screening and assessment of dysphagia in patients with neuromuscular diseases in Europe.
All results will be anonymous with respect to institutions and names of participants for any public communication. All participants will receive the results of the survey.
We particularly appreciate your cooperation and thank you already for your collaboration and your time. In order to make this survey as broad as possible, do not hesitate to forward this survey to any professionals concerned by NMD patients in Europe, as possible.
Link to survey in different languages:
English: https://goo.gl/forms/RIRW29Ef3EKMRHhZ2
German: https://goo.gl/forms/wuIAtp0GJglPKWEG3
Dutch: https://goo.gl/forms/8aLJlpDLbhUTVWYI2
French: https://goo.gl/forms/chrk4mAiJyiT7CFS2
Italian: https://goo.gl/forms/e8RHpT3GVHwaKadD2
Spanish:https://forms.gle/3WFJRForwVFb86Qg6
Sincerely yours,
Nicolas Audag (PT, Msc)
Cliniques universitaires Saint-Luc
Belgium
Michel Toussaint (PT, PhD)
Inkendaal - Koninklijke Instelling
Belgium
Grégory Reychler (PT, PhD)
Cliniques universitaires Saint-Luc
Belgium
If you have any questions, you can contact: nicolas.audag@uclouvain.be