The study examines if diagnostic ultrasound imaging of larynx and diaphragm can be as accurate as transnasal fiberoptic laryngoscopy in visualizing the larynx during NIV and Mechanically Assisted Cough interventions.
Transnasal fiberoptic laryngoscopy (TFL) is gold standard for visualising the larynx. TFL has been used to visualize the laryngeal response patterns during non-invasive therapeutic interventions, as during Mechanically Assisted Cough in patients with Amyotrophic Lateral Sclerosis. The examinations revealed that the larynx adducted during the application of positive pressures, which restricted the airflow and reduced the efficacy of the treatment. The higher treatment pressures resulted in ineffective interventions as a result of the adducted vocal cords obstructing flow. This knowledge has changed the treatment approach for patients with possible upper airway instability by individualizing the treatment pressures and flow due to laryngeal responses. TFL may cause slight discomfort when placing the laryngoscope. Diagnostic ultrasound is non-invasive easily applicable technique that has gained increasing popularity in diagnosing cardiopulmonary and laryngeal conditions during the recent times. The aim of the study is to investigate whether the diagnostic ultrasound of the larynx can be as accurate as TFL during Mechanically Assisted Cough and Non-Invasive Ventilation (NIV). The present study will include healthy participants. Hypothesis is that diagnostic ultrasound of larynx can provide clinical valuable information of the laryngeal response patterns during Mechanically Assisted Cough and NIV. The aims of the study are: * To evaluate the feasibility of diagnostic ultrasound imaging of the larynx, and to compare to the gold standard of TFL used during ongoing NIV and Mechanically Assisted Cough in healthy subjects. * To evaluate the feasibility of ultrasound imaging if the diaphragm during ongoing NIV and Mechanically Assisted Cough in healthy subjects.
Study Type
OBSERVATIONAL
Enrollment
30
To investigate if Ultrasound imaging can visualize the larynx during NIV and Cough Assist, and be as accurate as laryngoscopy
To investigate if Ultrasound imaging can visualize the larynx during NIV and Cough Assist, and be as accurate as laryngoscopy
Haukeland University Hospital
Bergen, Vestlandet, Norway
Opening movements in larynx on transnasal fiberoptic laryngoscopy (TFL) during inspiration
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Obstructive movements in larynx on TFL during inspiration
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Closure in larynx on TFL during the compression phase of cough
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Opening movements in larynx on TFL during expiration
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Narrower movements in larynx on TFL during expiration
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Obstructive movements in larynx on TFL during expiration
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Opening movements in larynx on Anterior Ultrasound (USA) during inspiration
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Obstructive movements in larynx on USA during inspiration
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Closure in larynx on USA during the compression phase of cough
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Opening movements in larynx on USA during expiration
Number of participants.
Time frame: Day 1
Narrower movements in larynx on USA during expiration
Number of participants.
Time frame: Day 1
Obstructive movements in larynx on USA during expiration
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Time frame: Day 1
Opening movements in larynx on Lateral Ultrasound (USL) during inspiration
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Time frame: Day 1
Obstructive movements in larynx on USL during inspiration
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Time frame: Day 1
Closure in larynx on USL during the compression phase of cough
Number of participants.
Time frame: Day 1
Opening movements in larynx on USL during expiration
Number of participants.
Time frame: Day 1
Narrower movements in larynx on USL during expiration
Number of participants.
Time frame: Day 1
Obstructive movements in larynx on USL during expiration
Number of participants.
Time frame: Day 1
Comparison of observed movements in the larynx on transnasal fiberoptic laryngoscopy (TFL) and Anterior Ultrasound (USA) imaging.
The chi-square test will assess differences between examination methods.
Time frame: Day 1
Comparison of observed movements in the larynx on transnasal fiberoptic laryngoscopy (TFL) and Lateral Ultrasound (USL) imaging.
The chi-square test will assess differences between examination methods.
Time frame: Day 1
Comparison of observed movements in the larynx on Anterior Ultrasound (USA) and Lateral Ultrasound (USL) imaging.
The chi-square test will assess differences between examination methods.
Time frame: Day 1
Ultrasound imaging of diaphragm excursion
Measurements will be performed in quiet breathing, NIV and Cough Assist. Diaphragm excursions are recorded in M-mode, and will be presented in millimeters.
Time frame: Day 1
Subjects perception of the examination with TFL - VAS scale
Participant's experience of the examination will be evaluated on a Visual Analog Scale (VAS) from 0-10 where higher number indicate more discomfort.
Time frame: Day 1
Subjects perception of the examination with Laryngeal ultrasound - VAS scale
Participant's experience of the examination will be evaluated on a Visual Analog Scale (VAS) from 0-10 where higher number indicate more discomfort.
Time frame: Day 1
Airflow registration
A pneumotachograph inserted in the Circuit between the facemask and the therapeutic device will register airflow during the interventions. Interruptions of the airflow will verify the possible laryngeal adductions.
Time frame: Day 1
Pressure registration
A pressure transducer inserted in the Circuit between the facemask and the therapeutic device measures the pressure and verify the settings of the NIV and Mechanically assisted Cough.
Time frame: Day 1