Effects of Nasal Airflow on Sleep in Tracheotomized Patients

The use of invasive mechanical ventilation via an endotracheal tube or tracheotomy involves bypassing the nasopharyngeal space and abolishing nasal ventilation. The first consequence is the loss of olfactory function. This function is quickly recovered when nasal ventilation is made possible. However, the abolition of nasal ventilation may have consequences beyond the loss of olfaction. The abolition of nasal ventilation in intubated rats inhibits these rhythmic oscillations, which can be restored by nasal sprays. In humans, nasal ventilation induces cerebral activity in functional brain areas and is associated with better cognitive performance compared to oral ventilation. In a model of intubated and ventilated rats, it has been shown that nasal sprays synchronized with the ventilator reduce hippocampal lesions compared to animals ventilated with an endotracheal tube without nasal sprays. Finally, in patients intubated with an endotracheal tube for toxic comas, the same nasal spray system restored brain activity and neural connectivity.

The aim of this study is to test the effects of nasal airflow of the sleep in tracheostomized patients who are still dependent to invasive mechanical ventilation. Patients will be investigated by a full polysomnography during two consecutive nights, with and without nasal airflow on the top of invasive mechanical ventilation, the two nights being randomized.

Inclusion criteria

• Age ≥ 18 years
• Admission to PRRS for weaning from ventilation
• Tracheotomy and nocturnal invasive mechanical ventilation
• Indication for polysomnography by care team
• Agreement to participate by patient or trusted person/relative and signature of consent form
• Affiliation with a social security scheme or beneficiary

Exclusion criteria

• Diseases of the central nervous system: cerebrovascular accident (CVA), multiple sclerosis (MS), epilepsy
• Psychiatric illnesses (psychoses)
• Hyperthermia (temperature > 38.5°C)
• Agitation, resuscitation delirium
• Continuous use of sedatives
• Patients under legal protection (guardianship/curatorship)
• Patients deprived of liberty by judicial or administrative decision
• Patients under AME
• Pregnant or breast-feeding women