Glossopharyngeal breathing

Glossopharyngeal breathing (GPB, glossopharyngeal insufflation, buccal pumping, or frog breathing) is a means of pistoning air into the lungs to volumes greater than can be achieved by the person's breathing muscles (greater than maximum inspiratory capacity). The technique involves the use of the glottis to add to an inspiratory effort by gulping boluses of air into the lungs. It can be beneficial for individuals with weak inspiratory muscles and no ability to breathe normally on their own.

The technique was first observed by physicians in the late 1940s in polio patients at Rancho Los Amigos Hospital, in Los Angeles, by Dr Clarence W Dail ^[1] and first described by Dr. Dail in 1951 in the journal California Medicine.^[2]

Both inspiratory and, indirectly, expiratory muscle function can be assisted by GPB.^[3] GPB can provide an individual with weak inspiratory muscles and no vital capacity (VC) or breathing ventilator-free breathing tolerance with normal alveolar ventilation and perfect safety when not using a ventilator or in the event of sudden ventilator failure day or night.^[4][5] The technique involves the use of the glottis to add to an inspiratory effort by projecting (gulping) boluses of air into the lungs. The glottis closes with each "gulp". One breath usually consists of 6 to 9 gulps of 40 to 200 ml each. During the training period the efficiency of GPB can be monitored by spirometrically measuring the milliliters of air per gulp, gulps per breath, and breaths per minute. A training manual ^[6] and numerous videos are available,^[7] the most detailed of which was produced in 1999.^[8] For those who can not master GPB it is often because of inability of the soft palate to seal off the nose.

Although severe oropharyngeal muscle weakness can limit the usefulness of GPB, Baydur et al^[9] reported two DMD ventilator users who were very successful using it. We have managed 11 Duchenne muscular dystrophy ventilator users who had no breathing tolerance other than by GPB. Approximately 60% of ventilator users with no autonomous ability to breathe and good bulbar muscle function ^[10][11] can use GPB for autonomous breathing from minutes to up to all day. Patients with no vital capacity have awoken from sleep using GPB to discover that their ventilators were no longer functioning. Some have spontaneously come out of anesthesia frog breathing and others out of grand mal convulsions surprisingly without being cyanotic, frog breathing.^[12]

Although potentially extremely useful, GPB is rarely taught since there are few health care professionals familiar with the technique. GPB is also rarely useful in the presence of an indwelling tracheostomy tube. It can not be used when the tube is uncapped as it is during tracheostomy mechanical ventilation (TMV), and even when capped, the gulped air tends to leak around the outer walls of the tube and out the stoma as airway volumes and pressures increase during the GPB air stacking process. In summary, GPB can be used for ventilator-free breathing, back-up in the event of ventilator failure, to increase cough flows, to increase speech volume and production per breath, and to improve pulmonary compliance. The safety and versatility afforded by GPB are key reasons to eliminate tracheostomy in favor of noninvasive aid).

Footnotes