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Kaminska M, Adam V, Orr JE. Home Noninvasive Ventilation in COPD. Chest 2024; 165:1372-1379. [PMID: 38301744 PMCID: PMC11177097 DOI: 10.1016/j.chest.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/19/2023] [Accepted: 01/15/2024] [Indexed: 02/03/2024] Open
Abstract
Evidence is increasing that long-term noninvasive ventilation (LTNIV) can improve outcomes in individuals with severe, hypercapnic COPD. Although the evidence remains unclear in some aspects, LTNIV seems to be able to improve patient-related and physiologic outcomes like dyspnea, FEV1 and partial pressure of carbon dioxide (Pco2) and also to reduce rehospitalizations and mortality. Efficacy generally is associated with reduction in Pco2. To achieve this, an adequate interface (mask) is essential, as are appropriate ventilation settings that target the specific respiratory physiologic features of COPD. This will ensure comfort, synchrony, and adherence that will result in physiologic improvements. This article briefly reviews the newest evidence and current guidelines on LTNIV in severe COPD. It describes an actual patient who benefitted from the therapy. Finally, it provides strategies for initiating and optimizing this LTNIV in COPD, discussing high-pressure noninvasive ventilation, optimization of triggering, and control of inspiratory time. As demand increases, clinicians will need to be familiar with this therapy to reap its benefits, because inadequately adjusted LTNIV will not be tolerated or effective.
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Affiliation(s)
- Marta Kaminska
- Quebec National Program for Home Ventilatory Assistance, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada; Division of Respiratory Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.
| | - Veronique Adam
- Quebec National Program for Home Ventilatory Assistance, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Jeremy E Orr
- Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, University of California, San Diego, La Jolla, CA
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Locke BW, Brown JP, Sundar KM. The Role of Obstructive Sleep Apnea in Hypercapnic Respiratory Failure Identified in Critical Care, Inpatient, and Outpatient Settings. Sleep Med Clin 2024; 19:339-356. [PMID: 38692757 PMCID: PMC11068091 DOI: 10.1016/j.jsmc.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
An emerging body of literature describes the prevalence and consequences of hypercapnic respiratory failure. While device qualifications, documentation practices, and previously performed clinical studies often encourage conceptualizing patients as having a single "cause" of hypercapnia, many patients encountered in practice have several contributing conditions. Physiologic and epidemiologic data suggest that sleep-disordered breathing-particularly obstructive sleep apnea (OSA)-often contributes to the development of hypercapnia. In this review, the authors summarize the frequency of contributing conditions to hypercapnic respiratory failure among patients identified in critical care, emergency, and inpatient settings with an aim toward understanding the contribution of OSA to the development of hypercapnia.
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Affiliation(s)
- Brian W Locke
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Jeanette P Brown
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Krishna M Sundar
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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Lefouili M, Arnol N, Journet S, Chauderon P, Adler D, Janssens JP, Pépin JL, Bailly S, Borel JC. Factors Associated With Change in S3-NIV Score Over Time in People With Chronic Respiratory Failure Treated With Long-Term Home Noninvasive Ventilation. Arch Bronconeumol 2024:S0300-2896(24)00165-0. [PMID: 38821776 DOI: 10.1016/j.arbres.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/09/2024] [Accepted: 05/11/2024] [Indexed: 06/02/2024]
Abstract
INTRODUCTION Monitoring changes in symptoms over time during long-term nocturnal home non-invasive ventilation (NIV) using patient-reported outcome measures is crucial. This study aimed to identify factors associated with changes in the S3-NIV total score, its two domains ("respiratory symptoms" and "sleep and NIV-related side effects") and individual item responses. METHODS We conducted a retrospective, longitudinal data analysis of a cohort of adults with chronic respiratory failure treated with NIV. Data were obtained from a French homecare provider. Multivariate linear and multinomial ordinal mixed effect models were used to identify factors associated with changes in S3-NIV scores over time. RESULTS Median follow-up was 2 years for 2135 participants. Each participant completed a median of five S3-NIV questionnaires; totaling 11,359 analyzed questionnaires. Type of respiratory condition, sex, age and time since NIV initiation were associated with change in S3-NIV score over time. NIV adherence was not associated with total S3-NIV score but high adherence was associated with more severe respiratory symptoms and an improvement in sleep and NIV-related side effects during the follow-up. Intensity of pressure support was associated with a lower total S3-NIV score and more side effects. Face masks and supplemental oxygen were associated with a lower S3-NIV total score. CONCLUSION Changes in S3-NIV scores over time are associated with the individual's characteristics and NIV settings. Analysis of the two domains and individual items of the S3-NIV could increase understanding of the difficulties experienced by people on NIV.
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Affiliation(s)
- Messaoud Lefouili
- HP2 Laboratory, INSERM U1300, University Grenoble Alpes, Grenoble 38000, France; AGIR à dom, Homecare Charity, Meylan 38240, France
| | | | | | | | - Dan Adler
- Division of Lung Diseases, Hôpital de la Tour, 1217 Meyrin, Geneva, Switzerland
| | - Jean-Paul Janssens
- Cardio-Respiratory Center, Hôpital de la Tour, 1217 Meyrin, Geneva, Switzerland
| | - Jean-Louis Pépin
- HP2 Laboratory, INSERM U1300, University Grenoble Alpes, Grenoble 38000, France; EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble 38000, France
| | - Sébastien Bailly
- HP2 Laboratory, INSERM U1300, University Grenoble Alpes, Grenoble 38000, France; EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble 38000, France
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Mathieu L, Rabec C, Beltramo G, Aho S, Tankere P, Schenesse D, Chorvoz J, Bonniaud P, Georges M. Real-life evaluation of NIV to CPAP switch in patients with chronic respiratory failure. A case control study. Respir Med Res 2024; 86:101114. [PMID: 38875850 DOI: 10.1016/j.resmer.2024.101114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Non-invasive ventilation (NIV) is a standard of care for hypercapnic chronic respiratory failure (CRF). Obstructive sleep apnea syndrome (OSA) frequently contributes to hypoventilation in CRF patients. CPAP improves hypercapnia in selected COPD and obese patients, like NIV. We aimed to describe the profile of patients switching from NIV to CPAP in a cohort of patients on long-term ventilation and to identify the factors associated with a successful switch. METHODS In this case-control study, 88 consecutive patients who were candidates for a NIV-CPAP switch were compared with 266 controls among 394 ventilated patients treated at the Dijon University Hospital between 2015 and 2020. They followed a standardized protocol including a poly(somno)graphy recorded after NIV withdrawal for three nights. CPAP trial was performed if severe OSA was confirmed. Patients were checked for recurrent hypoventilation after 1 and 23[14-46] nights under CPAP. RESULTS Patients were 53% males, median age 65 [56-74] years, and median BMI 34 [25-38.5] kg/m2. Sixty four percent of patients were safely switched and remained on long-term CPAP. In multivariate analysis, the probability of a NIV-CPAP switch was correlated to older age (OR: 1.3 [1.01-1.06]), BMI (OR: 1.7 [1.03-1.12]), CRF etiology (OR for COPD: 20.37 [4.2-98,72], OR for obesity: 7.31 [1.58-33.74]), circumstances of NIV initiation (OR for acute exacerbation: 11.64 [2.03-66.62]), lower pressure support (OR: 0.90 [0.73-0.92]), lower baseline PaCO2 (OR: 0.85 [0.80-0.91]) and lower compliance (OR: 0.76 [0.64-0.90]). Among 72 patients who went home under CPAP, pressure support level was the only factor associated with the outcome of the NIV-CPAP switch, even after adjustment for BMI and age (p=0.01) with a non-linear correlation. Etiology of chronic respiratory failure, age, BMI, baseline PaCO2, circumstances of NIV initiation, time under home NIV or NIV compliance were not predictive of the outcome of the NIV-CPAP switch. CONCLUSIONS A NIV-CPAP switch is possible in real life conditions in stable obese and COPD patients with underlying OSA.
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Affiliation(s)
- Louise Mathieu
- Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France
| | - Claudio Rabec
- Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France
| | - Guillaume Beltramo
- Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France; INSERM LNC-UMR 1231, Dijon, France
| | - Serge Aho
- Department of Epidemiology, Dijon University Hospital, Dijon, France
| | - Pierre Tankere
- Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France
| | - Déborah Schenesse
- Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France
| | - Jade Chorvoz
- Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France
| | - Philippe Bonniaud
- Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France; INSERM LNC-UMR 1231, Dijon, France
| | - Marjolaine Georges
- Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France; Centre des Sciences du Goût et de l'Alimentation, UMR 6265 CNRS 1234 INRA, University of Bourgogne Franche-Comté, Dijon, France.
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Saigal A, Shah AJ, Mandal S. Indications and evidence for domiciliary noninvasive ventilation. Expert Rev Respir Med 2023; 17:1141-1150. [PMID: 38112122 DOI: 10.1080/17476348.2023.2295941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Home noninvasive ventilation (HNIV) has expanded globally, with a greater evidence base for its use. HNIV improves multiple patient related outcomes in patients with chronic hypercapnic respiratory failure. Obesity hypoventilation syndrome (OHS) is rapidly taking over as the primary indication for HNIV and COPD patients who overlap with obstructive sleep apnea hypoventilation syndromes (OSAHS) and are increasingly recognized but add to the complexity of HNIV prescribing. Optimal settings vary for differing diseases, with higher inspiratory pressures often required in those with OHS and COPD, yet which settings translate into greatest patient benefit remains unknown. AREAS COVERED We cover the evidence base underpinning the common indications for HNIV in COPD, OHS, neuromuscular disease (NMD), and chest wall disease (CWD) and highlight common HNIV modes used. EXPERT OPINION Active screening for nocturnal hypoventilation in OHS and COPD may be important to guide earlier ventilation. Further research on which HNIV modalities best improve patient related outcomes and the right time for initiation in different patient phenotypes is rapidly needed. Worldwide, clinical research trials should aim to bridge the gap by reporting on patient-related outcomes and cost effectiveness in real-world populations to best understand the true benefit of HNIV amongst heterogenous patient populations.
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Affiliation(s)
- Anita Saigal
- Respiratory Department, University College London, London, UK
- Thoracic Department, Royal Free London NHS Foundation Trust, London, UK
| | - Amar J Shah
- Respiratory Department, University College London, London, UK
- Thoracic Department, Royal Free London NHS Foundation Trust, London, UK
| | - Swapna Mandal
- Respiratory Department, University College London, London, UK
- Thoracic Department, Royal Free London NHS Foundation Trust, London, UK
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Couturier H, Rolland-Debord C, Gillibert A, Jolly G, Fresnel E, Cuvelier A, Patout M. An exposed/unexposed cohort study assessing the effectiveness, the safety and the survival of patients established on home non-invasive ventilation after 80 years old. Respir Med Res 2023; 84:101014. [PMID: 37302159 DOI: 10.1016/j.resmer.2023.101014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/26/2023] [Accepted: 03/18/2023] [Indexed: 03/28/2023]
Abstract
BACKGROUND Little is known about the use of long-term non-invasive ventilation (NIV) in the elderly. We aimed to assess if the effectiveness of long-term NIV of patients ≥ 80 years (older) was not greatly inferior to that of patients < 75 years (younger). METHODS This retrospective exposed/unexposed cohort study included all patients established on long-term NIV treated at Rouen University Hospital between 2017 and 2019. Follow-up data were collected at the first visit following NIV initiation. The primary outcome was daytime PaCO2 with a non-inferiority margin of 50% of the improvement of PaCO2 for older patients compared to younger patients. RESULTS We included 55 older patients and 88 younger patients. After adjustment on the baseline PaCO2, the mean daytime PaCO2 was reduced by 0.95 (95% CI: 0.67; 1.23) kPa in older patients compared to1.03 (95% CI: 0.81; 1.24) kPa in younger patients for a ratio of improvements estimated at 0.95/1.03 = 0.93 (95% CI: 0.59; 1.27, one-sided p = 0.007 for non-inferiority to 0.50). Median (interquartile range) daily use was 6 (4; 8.1) hours in older versus 7.3 (5; 8.4) hours in younger patients. No significant differences were seen in the quality of sleep and NIV safety. The 24-months survival was 63.6% in older and 87.2% in younger patients. CONCLUSIONS effectiveness and safety seemed acceptable in older patients, with a life expectancy long enough to expect a mid-term benefit, suggesting that initiation of long-term NIV should not be refused only based on age. Prospective studies are needed.
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Affiliation(s)
- Hugo Couturier
- Service de Pneumologie, oncologie thoracique, Soins Intensifs Respiratoires, Rouen University Hospital, Rouen University, Rouen, France
| | - Camille Rolland-Debord
- Service de Pneumologie. CHU Gabriel Montpied. Clermont-Ferrand, Université Clermont Auvergne, France
| | - André Gillibert
- Department of Biostatistics, CHU Rouen, F-76000 Rouen, France
| | - Grégoire Jolly
- Service de Réanimation Médicale, Rouen University Hospital, Rouen University, Rouen, France
| | | | - Antoine Cuvelier
- Service de Pneumologie, oncologie thoracique, Soins Intensifs Respiratoires, Rouen University Hospital, Rouen University, Rouen, France; EA3830 GRHV, Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIRouen, Rouen, France
| | - Maxime Patout
- Service des Pathologies du Sommeil (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France; URMS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, Paris, France
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Pepin JL, Lemeille P, Denis H, Josseran A, Lavergne F, Panes A, Bailly S, Palot A, Prigent A. Health trajectories before initiation of non-invasive ventilation for chronic obstructive pulmonary disease: a French nationwide database analysis. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100717. [PMID: 37927425 PMCID: PMC10625021 DOI: 10.1016/j.lanepe.2023.100717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/21/2023] [Accepted: 08/01/2023] [Indexed: 11/07/2023]
Abstract
Background Chronic obstructive pulmonary disease (COPD) is the most common indication for long-term domiciliary non-invasive ventilation (NIV) but there is uncertainty in data supporting current guidelines. This study described health trajectories before initiation of at-home NIV in people with COPD, and compared mortality outcomes between groups with different pre-NIV health trajectories. Methods Data were from the French national health insurance reimbursement system database for individuals with COPD aged ≥40 years and ≥1 reimbursement for NIV between 1 January 2015 and 31 December 2019. Common health trajectories were determined using time sequence analysis through K-clustering (TAK analysis). Findings Data from 54,545 individuals were analysed; the population was elderly (median age 70 years) with multiple comorbidities. Four clusters were generated. Cluster 1 (n = 35,975/54,545; 66%) had NIV initiated in ambulatory settings or after the first acute event/exacerbation. Cluster 2 (6653/54,545; 12%) started NIV after ≥2 severe exacerbations in the previous 6 months. Cluster 3 (11,375/54,545; 21%) started NIV after frequent severe COPD-related exacerbations in the previous year. Cluster 4 (652/54,545; 1%) started NIV after many long-lasting severe exacerbations. The four clusters differed in age, sex, comorbidities, pre-NIV investigations, and prescriber/location of NIV initiation. Mortality differed significantly between clusters: highest in Cluster 4 and lowest in Cluster 1. Interpretation The significant heterogeneity in clinical initiation of NIV probably reflects the current lack of strong evidence and guideline recommendations. Knowledge about the characteristics and outcomes in different clusters should be used to address inequities and facilitate more consistent and personalised use domiciliary NIV in COPD. Funding JLP and SB are supported by the French National Research Agency in the framework of the "Investissements d'avenir" program (ANR-15-IDEX-02) and the "e-health and integrated care and trajectories medicine and MIAI artificial intelligence (ANR-19-P3IA-0003)" Chairs of excellence from the Grenoble Alpes University Foundation. This work was supported by ResMed.
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Affiliation(s)
- Jean-Louis Pepin
- University Grenoble Alpes, Inserm U1300, CHU Grenoble Alpes, HP2, Grenoble, France
| | | | | | | | | | | | - Sébastien Bailly
- University Grenoble Alpes, Inserm U1300, CHU Grenoble Alpes, HP2, Grenoble, France
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Chung Y, Garden FL, Marks GB, Vedam H. Causes of hypercapnic respiratory failure: a population-based case-control study. BMC Pulm Med 2023; 23:347. [PMID: 37710243 PMCID: PMC10503117 DOI: 10.1186/s12890-023-02639-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVE There are no population-based data on the relative importance of specific causes of hypercapnic respiratory failure (HRF). We sought to quantify the associations between hospitalisation with HRF and potential antecedent causes including chronic obstructive pulmonary disease (COPD), obstructive sleep apnea, and congestive cardiac failure. We used data on the prevalence of these conditions to estimate the population attributable fraction for each cause. METHODS A case-control study was conducted among residents aged ≥ 40 years from the Liverpool local government area in Sydney, Australia. Cases were identified from hospital records based on PaCO2 > 45 mmHg. Controls were randomly selected from the study population using a cluster sampling design. We collected self-reported data on medication use and performed spirometry, limited-channel sleep studies, venous sampling for N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, and sniff nasal inspiratory pressure (SNIP) measurements. Logistic regression analyses were performed using directed acyclic graphs to identify covariates. RESULTS We recruited 42 cases and 105 controls. HRF was strongly associated with post-bronchodilator airflow obstruction, elevated NT-proBNP levels, reduced SNIP measurements and self-reported opioid medication use. There were no differences in the apnoea-hypopnea index or oxygen desaturation index between groups. COPD had the highest population attributable fraction (42%, 95% confidence interval 18% to 59%). CONCLUSIONS COPD, congestive cardiac failure, and self-reported use of opioid medications, but not obstructive sleep apnea, are important causes of HRF among adults over 40 years old. No single cause accounts for the majority of cases based on the population attributable fraction.
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Affiliation(s)
- Yewon Chung
- School of Clinical Medicine, South Western Sydney Clinical Campuses, Discipline of Medicine, UNSW Sydney, Sydney, Australia.
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Locked Bag 7103 Liverpool, Liverpool, Sydney, NSW, BC 1871, Australia.
- Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia.
| | - Frances L Garden
- School of Clinical Medicine, South Western Sydney Clinical Campuses, Discipline of Medicine, UNSW Sydney, Sydney, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia
| | - Guy B Marks
- School of Clinical Medicine, South Western Sydney Clinical Campuses, Discipline of Medicine, UNSW Sydney, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Locked Bag 7103 Liverpool, Liverpool, Sydney, NSW, BC 1871, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia
| | - Hima Vedam
- School of Clinical Medicine, South Western Sydney Clinical Campuses, Discipline of Medicine, UNSW Sydney, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Locked Bag 7103 Liverpool, Liverpool, Sydney, NSW, BC 1871, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia
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van den Biggelaar R, Hazenberg A, Duiverman ML. The role of telemonitoring in patients on home mechanical ventilation. Eur Respir Rev 2023; 32:32/168/220207. [PMID: 37019457 PMCID: PMC10074164 DOI: 10.1183/16000617.0207-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/13/2022] [Indexed: 04/07/2023] Open
Abstract
There is a growing number of patients being treated with long-term home mechanical ventilation (HMV). This poses a challenge for the healthcare system because in-hospital resources are decreasing. The application of digital health to assist HMV care might help. In this narrative review we discuss the evidence for using telemonitoring to assist in initiation and follow-up of patients on long-term HMV. We also give an overview of available technology and discuss which parameters can be measured and how often this should be done. To get a telemonitoring solution implemented in clinical practice is often complex; we discuss which factors contribute to that. We discuss patients' opinions regarding the use of telemonitoring in HMV. Finally, future perspectives for this rapidly growing and evolving field will be discussed.
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Affiliation(s)
- Ries van den Biggelaar
- Dept of Pulmonary Diseases/Home Mechanical Ventilation, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Anda Hazenberg
- Dept of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marieke L Duiverman
- Dept of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Agossou M, Simo-Tabué N, Dufeal M, Awanou B, Provost M, Smith K, Badaran E, Zouzou A, Ahouansou N, Tabué-Teguo M, Dramé M. Profiles of Elderly Patients with Obesity Hypoventilation Syndrome in Martinique: A Single-Center Study. J Pers Med 2023; 13:1089. [PMID: 37511702 PMCID: PMC10381235 DOI: 10.3390/jpm13071089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
Obesity hypoventilation syndrome (OHS) is a form of chronic respiratory insufficiency related to obesity that affects young and old people. Age appears to be associated with poorer response to treatment by nighttime ventilation. This study aimed to describe the characteristics of elderly subjects (>65 years) with OHS compared to younger patients, with a view to adapting therapy in older individuals. We conducted a retrospective study comparing socio-demographic, clinical, functional characteristics as well as treatment and outcomes between young (<65 years) and older (65 years and older) individuals with OHS at the University Hospital of Martinique. We included 143 patients (114 women), of whom 82 were 65 years or older (57%). Charlson index was higher in the older group. Patients in ≥65 years group were less frequently obese, but more frequently had diabetes mellitus, cardiac arrythmia and arterial hypertension compared to younger patients. There was no difference in the circumstances of diagnosis or arterial blood gas at diagnosis. At follow up, partial pressure of carbon dioxide (pCO2) was higher in ≥65 years group. Despite comparable NIV settings, apart from lower expiratory positive airway pressure (EPAP) with higher apnea-hypopnea index (AHI), patients in the ≥65-year-old group remained more frequently hypercapnic. In conclusion, over half (57%) of patients with OHS in our cohort were aged over 65 years. Older patients developed OHS at lower BMI levels than their younger counterparts, and more frequently, had comorbidities such as diabetes, hypertension and cardiac arrhythmia. Increased Charlson index, lower BMI and female sex were independent factors associated with OHS in the elderly.
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Affiliation(s)
- Moustapha Agossou
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Nadine Simo-Tabué
- Department of Geriatrics, CHU of Martinique, 97261 Fort-de-France, France
- EpiCliV Research Unit, Faculty of Medicine, University of the French West Indies, 97261 Fort-de-France, France
| | - Marion Dufeal
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Bérénice Awanou
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Mathilde Provost
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Ketty Smith
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Elena Badaran
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Adel Zouzou
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Nelly Ahouansou
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Maturin Tabué-Teguo
- Department of Geriatrics, CHU of Martinique, 97261 Fort-de-France, France
- EpiCliV Research Unit, Faculty of Medicine, University of the French West Indies, 97261 Fort-de-France, France
| | - Moustapha Dramé
- EpiCliV Research Unit, Faculty of Medicine, University of the French West Indies, 97261 Fort-de-France, France
- Department of Clinical Research and Innovation, CHU of Martinique, 97261 Fort-de-France, France
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Carlucci A, Patout M, Winck JC. Does one size fit all? An update on chronic ventilatory support in different respiratory illnesses. Breathe (Sheff) 2023; 19:230046. [PMID: 37492344 PMCID: PMC10365079 DOI: 10.1183/20734735.0046-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/15/2023] [Indexed: 07/27/2023] Open
Abstract
Home noninvasive ventilation (HNIV) improves outcomes in different disease categories. In this article, we discuss indications for when and how to initiate HNIV in COPD, obesity hypoventilation syndrome (OHS) and neuromuscular disorders (NMD). While in COPD, significant diurnal hypercapnia and high-intensity HNIV are essential ingredients for success, in NMD and OHS, early respiratory changes are best detected during sleep through oxy-capnography associated (or not) with respiratory polygraphy. In COPD and OHS, it is crucial to consider the coexistence of obstructive sleep apnoea because treatment with continuous positive airway pressure may be the simplest and most effective treatment that should be proposed even in hypercapnic patients as first-line therapy. In NMD, the need for continuous HNIV and eventual switching to tracheostomy ventilation makes this group's management more challenging. Achieving successful HNIV by improving quality of sleep, quality of life and keeping a good adherence to the therapy is a challenge, above all in COPD patients. In OHS patients, on top of HNIV, initiation of other interventions such as weight loss management is crucial. More resources should be invested in improving all these aspects. Telemonitoring represents a promising method to improve titration and follow-up of HNIV.
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Affiliation(s)
- Annalisa Carlucci
- Dipartimento di Medicina e Chirurgia Malattie dell'Apparato Respiratorio, Università degli Studi dell'Insubria, Varese, Italy
- U.O. di Pneumologia Riabilitativa, Istituti Clinici Scientifici Maugeri, IRCCS Pavia, Pavia, Italy
| | - Maxime Patout
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - João Carlos Winck
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Centro de Reabilitação do Norte, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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12
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Delorme M, Leotard A, Lebret M, Lefeuvre C, Hazenberg A, Pallero M, Nickol AH, Hannan LM, Boentert M, Yüksel A, Windisch W, Howard ME, Hart N, Wijkstra PJ, Prigent H, Pepin JL, Lofaso F, Khouri C, Borel JC. Effect of Intensity of Home Noninvasive Ventilation in Individuals With Neuromuscular and Chest Wall Disorders: A Systematic Review and Meta-Analysis of Individual Participant Data. Arch Bronconeumol 2023:S0300-2896(23)00156-4. [PMID: 37217384 DOI: 10.1016/j.arbres.2023.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Home noninvasive ventilation (NIV), targeting a reduction of carbon dioxide with a combination of sufficient inspiratory support and backup-rate improves outcomes in patients with chronic obstructive pulmonary disease. The aim of this systematic review with individual participant data (IPD) meta-analysis was to evaluate the effects of intensity of home NIV on respiratory outcomes in individuals with slowly progressive neuromuscular (NMD) or chest-wall disorders (CWD). METHODS Controlled, non-controlled and cohort studies indexed between January-2000 and December-2020 were sought from Medline, Embase and the Cochrane Central Register. Outcomes were diurnal PaCO2, PaO2, daily NIV usage, and interface type (PROSPERO-CRD 42021245121). NIV intensity was defined according to the Z-score of the product of pressure support (or tidal volume) and backup-rate. RESULTS 16 eligible studies were identified; we obtained IPD for 7 studies (176 participants: 113-NMD; 63-CWD). The reduction in PaCO2 was greater with higher baseline PaCO2. NIV intensity per se was not associated with improved PaCO2 except in individuals with CWD and the most severe baseline hypercapnia. Similar results were found for PaO2. Daily NIV usage was associated with improvement in gas exchange but not with NIV intensity. No association between NIV intensity and interface type was found. CONCLUSION Following home NIV initiation in NMD or CWD patients, no relationship was observed between NIV intensity and PaCO2, except in individuals with the most severe CWD. The amount of daily NIV usage, rather than intensity, is key to improving hypoventilation in this population during the first few months after introduction of therapy.
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Affiliation(s)
- Mathieu Delorme
- Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France; AFM-Téléthon, Direction des Actions Médicales, 91000 Evry, France
| | - Antoine Leotard
- Service de Physiologie et explorations fonctionnelles, GHU APHP - Paris Saclay - Hôpital Raymond Poincaré (APHP), 92380 Garches, France; Université Paris-Saclay, UVSQ, INSERM U1179, Equipe 3 «END:ICAP», 78000 Versailles, France
| | - Marius Lebret
- Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France
| | - Claire Lefeuvre
- Neurology Department, Raymond Poincaré University Hospital, Garches, APHP, France; Nord-Est-Ile-de-France Neuromuscular Reference Center, FHU PHENIX, France
| | - Anda Hazenberg
- University of Groningen, University Medical Center Groningen, Department of Pulmonology and Tuberculosis, Department of Home Mechanical Ventilation, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, GRIAC Research Institute, The Netherlands
| | - Mercedes Pallero
- Respiratory Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Annabel H Nickol
- Oxford Centre for Respiratory Medicine, Oxford University Hospital NHS Foundation Trust, Oxford OX3 7LE, UK; The Royal Brompton Hospital, London SW3 6NP, UK
| | - Liam M Hannan
- Department of Respiratory Medicine, Northern Health, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Melbourne, Australia; Dept of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Matthias Boentert
- Department of Neurology, Münster University Hospital (UKM), Münster, Germany; Department of Medicine, UKM-Marienhospital Steinfurt, Steinfurt, Germany
| | - Aycan Yüksel
- Ufuk University, Faculty of Medicine, Rıdvan Ege Hospital, Department of Pulmonology and Tuberculosis, Ankara, Turkey
| | - Wolfram Windisch
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln, gGmbH, Witten/Herdecke University, Germany
| | - Mark E Howard
- Institute for Breathing and Sleep, Melbourne, Australia; Dept of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Nicholas Hart
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK; Centre for Human and Applied Physiological Science, King's College London, London, UK
| | - Peter J Wijkstra
- University of Groningen, University Medical Center Groningen, Department of Pulmonology and Tuberculosis, Department of Home Mechanical Ventilation, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, GRIAC Research Institute, The Netherlands
| | - Hélène Prigent
- Service de Physiologie et explorations fonctionnelles, GHU APHP - Paris Saclay - Hôpital Raymond Poincaré (APHP), 92380 Garches, France; Université Paris-Saclay, UVSQ, INSERM U1179, Equipe 3 «END:ICAP», 78000 Versailles, France; FHU Phenix - GHU APHP - Paris Saclay - Hôpital Raymond Poincaré (APHP), 92380 Garches, France
| | - Jean-Louis Pepin
- HP2 (Hypoxia and Physio-Pathologies) Laboratory, Inserm (French National Institute of Health and Medical Research) U1300, University Grenoble Alpes, Grenoble, France; EFCR (Cardiovascular and Respiratory Function) Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Frederic Lofaso
- Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France; Service de Physiologie et explorations fonctionnelles, GHU APHP - Paris Saclay - Hôpital Raymond Poincaré (APHP), 92380 Garches, France
| | - Charles Khouri
- HP2 (Hypoxia and Physio-Pathologies) Laboratory, Inserm (French National Institute of Health and Medical Research) U1300, University Grenoble Alpes, Grenoble, France; Centre Régional de pharmacovigilance, Centre d'Investigation Clinique, CHU Grenoble Alpes, France
| | - Jean-Christian Borel
- HP2 (Hypoxia and Physio-Pathologies) Laboratory, Inserm (French National Institute of Health and Medical Research) U1300, University Grenoble Alpes, Grenoble, France; Research and Development Department, AGIR à dom Association, 36 Bd du Vieux Chêne, 38240 Meylan, France.
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13
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Kampelmacher MJ. Moving from Inpatient to Outpatient or Home Initiation of Non-Invasive Home Mechanical Ventilation. J Clin Med 2023; 12:jcm12082981. [PMID: 37109317 PMCID: PMC10144297 DOI: 10.3390/jcm12082981] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Home mechanical ventilation (HMV) is an effective treatment for patients with chronic hypercapnic respiratory failure caused by restrictive or obstructive pulmonary disorders. Traditionally, HMV is initiated in the hospital, nowadays usually on a pulmonary ward. The success of HMV, and especially non-invasive home mechanical ventilation (NIV), has led to a steep and ongoing increase in the incidence and prevalence of HMV, in particular for patients with COPD or obesity hypoventilation syndrome. Consequently, the number of available hospital beds to accommodate these patients has become insufficient, and models of care that minimize the use of (acute) hospital beds need to be developed. At present, the practices for initiation of NIV vary widely, reflecting the limited research on which to base model-of-care decisions, local health system features, funding models, and historical practices. Hence, the opportunity to establish outpatient and home initiation may differ between countries, regions, and even HMV centres. In this narrative review, we will describe the evidence regarding the feasibility, effectiveness, safety, and cost savings of outpatient and home initiation of NIV. In addition, the benefits and challenges of both initiation strategies will be discussed. Finally, patient selection and execution of both approaches will be examined.
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Affiliation(s)
- Mike J Kampelmacher
- Department of Pulmonology, Antwerp University Hospital, Drie Eikenstraat 655, B-2650 Antwerp, Belgium
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Campus Drie Eiken, Gebouw T3.30, Universiteitsplein 1, B-2610 Antwerp, Belgium
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14
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Chung Y, Garden FL, Marks GB, Vedam H. Causes of hypercapnic respiratory failure and associated in-hospital mortality. Respirology 2023; 28:176-182. [PMID: 36210347 PMCID: PMC10092076 DOI: 10.1111/resp.14388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/19/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Hypercapnic respiratory failure (HRF) can occur due to severe respiratory disease but also because of multiple coexistent causes. There are few data on the prevalence of antecedent causes for HRF and the effect of these causes on prognosis, especially where study inclusion has not been biased with respect to primary diagnosis, interventions received or clinical outcome. We sought to determine the prevalence of pre-specified conditions among patients with HRF and to determine the effect of these causes on in-hospital mortality. METHODS Cross-sectional study of patients with HRF from 2013 to 2017. Inclusion criteria were PaCO2 >45 mm Hg and pH ≤7.45. Causes of interest were identified using diagnosis codes from hospital records. We used directed acyclic graphs to inform logistic regression models for the outcome of in-hospital death. RESULTS We identified 873 persons with HRF in the study period. Mean (SD) age was 69 years and 50.4% were males. Acidosis (pH <7.35) was present in 488 (55%) cases. Most (83%) had one or more of the following: obstructive lung disease, lower respiratory tract infection, congestive cardiac failure, sleep disordered breathing, neuromuscular disease, opioid or benzodiazepine use. In-hospital mortality was 12.8%. Obstructive lung disease and cardiac failure were associated with a lower risk of death, whereas respiratory tract infection and neuromuscular disease were associated with increased risk of death. CONCLUSION HRF is associated with a range of potentially causative conditions, which significantly impact hospital survival. Systematic evaluation of patients with HRF may increase detection of treatable comorbidities.
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Affiliation(s)
- Yewon Chung
- South Western Sydney Clinical School, UNSW Medicine, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Frances L Garden
- South Western Sydney Clinical School, UNSW Medicine, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Guy B Marks
- South Western Sydney Clinical School, UNSW Medicine, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Hima Vedam
- South Western Sydney Clinical School, UNSW Medicine, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia
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15
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Pierucci P, Crimi C, Carlucci A, Palma L, Noto A, Carpagnano GE, Scala R. Long-term home noninvasive ventilation (LTHNIV) in restrictive thoracic diseases: the Italian snapshot. Monaldi Arch Chest Dis 2022; 93. [PMID: 36445246 DOI: 10.4081/monaldi.2022.2459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/19/2022] [Indexed: 12/03/2022] Open
Abstract
Long-term home noninvasive ventilation (LTHNIV) in restrictive thoracic diseases was explored via the recently published international REINVENT ERS survey. The Italian subset of respondents (ITA-r), the highest above all participating nations, was analyzed and compared to non-Italian respondents (NO-ITA-r). The ITA-r represented 20% of the total answers examined. Ninety-four percent were physicians, whose half worked in a respiratory ICU (RICU). ITA-r mainly worked in community hospitals vs NO-ITA-r who are largely affiliated with university hospitals (p<0.0001). Amyotrophic lateral sclerosis (ALS) was considered the most common medical condition leading to NIV indication by both ITA-r and NO-ITA-r (93% vs 78%, p>0.5). A greater proportion of ITA-r considered MIP/MEP the most important test for NIV initiation as compared to NO-ITA-r (p<0.05). There was no significant difference for both ITA-r and NO-ITA-r as regards the other questions. This study illustrates Italian LTHNIV practices in patients with NMD and it shows some important differences with the other countries' practices but agreement in terms of goals to achieve, reasons to initiate NIV, and practices among the two communities.
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Affiliation(s)
- Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital; Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, "Aldo Moro" University of Bari .
| | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania.
| | - Annalisa Carlucci
- Department of Medicine and Surgery, University of Insubria, Varese-Como; ICS Maugeri IRCCS, Pavia.
| | - Lavinia Palma
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital; Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, "Aldo Moro" University of Bari .
| | - Alberto Noto
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Division of Anesthesia and Intensive Care, University of Messina, Policlinico "G. Martino", Messina; IPCF-CNR, Institute for Chemical and Physical Processes, National Research Council, Messina .
| | - Giovanna Elisiana Carpagnano
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital; Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, "Aldo Moro" University of Bari .
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo.
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16
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Ribeiro C, Jácome C, Oliveira P, Conde S, Windisch W, Nunes R. Patients experience regarding home mechanical ventilation in an outpatient setting. Chron Respir Dis 2022; 19:14799731221137082. [PMID: 36417310 PMCID: PMC9706049 DOI: 10.1177/14799731221137082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The patient's experience of treatment is a cornerstone of high-quality healthcare, along with clinical safety and effectiveness. We aimed to evaluate the patients' perspectives regarding home mechanical ventilation (HMV) follow up in an outpatient setting and ascertain differences between patients that started HMV in the outpatient setting compared to other settings. METHODS This cross-sectional study was conducted with patients with chronic respiratory failure under HMV in the Outpatient Ventilation Clinic. Patients filled in a patient experience questionnaire and the S3-NIV questionnaire. RESULTS The study included 235 patients (127, 54% male), median 70 [25-75 percentiles 64-76] years) and about half were adapted to HMV in the outpatient setting (117, 49.8%). Patients had a daily ventilator usage of 8.0 [6.0-10.0] hours and have been on ventilator for a median of 35.0 [12.0-66.0] months. Patients reported an overall good experience regarding education at initiation (209 [88.9%] considered the information given was enough), short time to adaptation [104 (44.3%) felt adapted after some hours], with perceived benefits (171 [72.8%] reported less shortness of breath, 158 (67.2%) improved quality of life and 150 (63.8%) less tiredness). Benefits overcame the treatment side-effects (158 [67.2%] reported mucosal dryness, 109 (46.4%) mask sores and 96 (40.9%) leaks). There was no difference in terms of reported health gains, side effects or time to adaptation between adaptation settings, but patients starting HMV in the outpatient setting reported better communication and education at adaptation. CONCLUSIONS Outpatient setting was perceived as a positive experience, both in HMV initiation and follow up, with good patient-physician communication leading to significant health reported gains, improvement of health status and well-being and good treatment adherence.
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Affiliation(s)
- Carla Ribeiro
- Pulmonology Department,
Centro
Hospitalar de Vila Nova de
Gaia/Espinho, Vila Nova de Gaia, Portugal,Carla Ribeiro, Pulmonology Department,
Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes s/n,
Vila Nova de Gaia 4434-502, Portugal.
| | - Cristina Jácome
- CINTESIS@RISE, MEDCIDS,
Faculty of
Medicine of the University of Porto,
Porto, Portugal
| | - Pedro Oliveira
- ISPUP-EPI Unit, Instituto de
Ciências Biomédicas de Abel Salazar, Universidade do
Porto, Portugal
| | - Sara Conde
- Pulmonology Department,
Centro
Hospitalar de Vila Nova de
Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Wolfram Windisch
- Faculty of Health/School of
Medicine, Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt
Köln gGmbH, Witten/Herdecke University, Cologne,
Germany
| | - Rui Nunes
- Faculty of Medicine,
University
of Porto, Porto, Portugal
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17
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Ribeiro C, Jácome C, Castro L, Conde S, Windisch W, Nunes R. Long-term health-related quality of life in patients on home mechanical ventilation. BMC Pulm Med 2022; 22:433. [DOI: 10.1186/s12890-022-02236-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
It is fundamental to optimize and retain health-related quality of life (HRQoL) in the long term in patients with home mechanical ventilation (HMV). Therefore, this study aimed to evaluate the evolution of the HRQoL in patients already established on HMV across a period of 5 years and whether the HRQoL is associated with mortality.
Methods
This was a 5-year longitudinal cohort study conducted in an Outpatient Ventilation Clinic. Consecutive patients on HMV for at least 30 days responded to the Severe Respiratory Insufficiency (SRI) questionnaire at inclusion and again at 5 years.
Results
A total of 104 patients were included (male 56.7%, median age 69 [P25;P75] [61;77] years). Almost half of the patients had COPD (49.0%). Patients were on HMV for a median of 43.5 [22;85.5] months, with overall good adherence (median 8 [6;9] daily hours). Fifty-seven (54.8%) patients were alive at 5 years. In surviving patients, the only difference with statistical significance was in the attendant symptoms and sleep subscale, with patients scoring 7.1 [-4.5;25] points higher in the final questionnaire (p = 0.002). Survivors had significantly better scores in the SRI at inclusion than deceased patients (median 59.6 [49.2;71.7] vs 48.7 [38.4;63.2]; p = 0.004).
Conclusions
These results shows that HRQoL remains stable in surviving patients with HMV at five years. It also suggests that SRI can be of important prognostic value and help predict the terminal phase of the disease course in patients with long-term HMV.
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van den Biggelaar RJ, Hazenberg A, Cobben NA, Gaytant MA, Gommers DA, Wijkstra PJ. Starting HMV at home: a reasonable option for many patients? BMC Pulm Med 2022; 22:410. [DOI: 10.1186/s12890-022-02195-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 09/29/2022] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background and objective
In the current study, we undertook a more detailed exploration of the reasons why patients undergoing HMV were screened out of a recently published study in order to better understand how applicable home initiation of HMV is under real life conditions.
Methods
All referred patients who had an indication for starting HMV were screened to participate in the Homerun study. In this trial 512 patients were screened out of the study. Those patients not enrolled in the trial were divided into the following 3 groups: (1) those not fulfilling the inclusion criteria; 2) those meeting the exclusion criteria and 3) those excluded on the basis of medical or organisation reasons. Each group was then further divided into those who would likely have been suitable for initiation of HMV at home in real world practice and those who were unsuitable.
Results
Based on inclusion criteria (group 1) 116 patients could not start HMV in real life, while this was 245 patients in the study. Based on the exclusion criteria (group 2) 11 patients could not start in real life while this was 79 in the study. One hundred and eighty-eight could not be enrolled in the study due to medical and organisational reasons ( group 3), while in real life this was only 95.
Conclusion
This study indicates that more than 55% of patients who did not participate in the Homerun study could have started HMV at home in real life.
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19
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Growth of home respiratory equipment from 2006 to 2019 and cost control by health policies. Respir Med Res 2022; 82:100930. [DOI: 10.1016/j.resmer.2022.100930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/08/2022] [Accepted: 06/04/2022] [Indexed: 11/21/2022]
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20
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Wei Y, Pei J, Yang Q, Zhang H, Cui Y, Guo J, Guo X, Ma Y, Han L. The prevalence and risk factors of facial pressure injuries related to adult non-invasive ventilation equipment: A systematic review and meta-analysis. Int Wound J 2022; 20:621-632. [PMID: 35899399 PMCID: PMC9927905 DOI: 10.1111/iwj.13903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/05/2022] [Indexed: 01/16/2023] Open
Abstract
To systematically assess the prevalence of facial pressure injuries related to adult non-invasive ventilation equipment, and risk factors of facial pressure injuries. PubMed, Cochrane Library, Web of Science, Embase, China Knowledge Resource Integrated Database, Wanfang Database, Chinese Biomedical Database and Weipu Database were comprehensively searched for observational studies investigating the prevalence and risk factors of facial pressure injuries related to adult non-invasive ventilation equipment from inception to May 16th, 2022. Filter articles based on inclusion and exclusion criteria. The quality of the included studies was evaluated independently by two investigators. Meta-analysis was conducted using Stata 16.0 software package. In total, 2835 articles were screened and data from 12 studies were used in meta-analysis. The prevalence of facial pressure injuries related to adult non-invasive ventilation equipment was 25% (95% confidence interval, CI:15% to 37%, I2 = 97.34%, P < 0.0001). After controlling for confounding variables, the following risk factors of facial pressure injuries: use equipment form, with diabetes, fever, cumulative time of using equipment, facial skin oedema and Glasgow score. Understanding the risk factors of facial pressure injuries can provide the healthcare personnel with the theoretical basis for the management and treatment of the patients.
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Affiliation(s)
- Yuting Wei
- Evidence‐based Nursing CenterSchool of Nursing, Lanzhou UniversityLanzhouChina
| | - Juhong Pei
- First Clinical School of MedicineLanzhou UniversityLanzhouChina
| | - Qiuxia Yang
- First Clinical School of MedicineLanzhou UniversityLanzhouChina
| | - Hongyan Zhang
- Department of NursingGansu Provincial HospitalLanzhouChina
| | - Yutong Cui
- Evidence‐based Nursing CenterSchool of Nursing, Lanzhou UniversityLanzhouChina
| | - Jiali Guo
- Evidence‐based Nursing CenterSchool of Nursing, Lanzhou UniversityLanzhouChina
| | - Xiaojing Guo
- Evidence‐based Nursing CenterSchool of Nursing, Lanzhou UniversityLanzhouChina
| | - Yuxia Ma
- Evidence‐based Nursing CenterSchool of Nursing, Lanzhou UniversityLanzhouChina
| | - Lin Han
- Evidence‐based Nursing CenterSchool of Nursing, Lanzhou UniversityLanzhouChina,Department of NursingGansu Provincial HospitalLanzhouChina
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21
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Toussaint M, Wijkstra PJ, McKim D, Benditt J, Winck JC, Nasiłowski J, Borel JC. Building a home ventilation programme: population, equipment, delivery and cost. Thorax 2022; 77:thoraxjnl-2021-218410. [PMID: 35868847 PMCID: PMC9606503 DOI: 10.1136/thoraxjnl-2021-218410] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/31/2022] [Indexed: 11/03/2022]
Abstract
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, such evidence is scattered in the existing literature. We searched Medline for publications in English and French from 2005 to 2020. This narrative review analyses 24 international programmes of HMV. The estimated prevalence (min-max) of HMV is ±7.3/100 000 population (1.2-47), all disorders combined. The prevalence of HMV is associated with the gross domestic product per capita in these 24 countries. The prevalence of NMD is about 30/100 000 population, of which ±10% would use HMV. Nocturnal (8/24 hour), discontinuous (8-16/24 hours) and continuous (>16/24 hours) ventilation is likely to concern about 60%, 20% and 20% of NMD patients using HMV. A minimal budget of about 168€/patient/year (504€/100 000 population), including the cost of equipment solely, should address the cost of HMV equipment in low-income countries. When services and maintenance are included, the budget can drastically increase up to between 3232 and 5760€/patient/year. Emerging programmes of HMV in developing countries reveal the positive impact of international cooperation. Today, at least 12 new middle, and low-income countries are developing HMV programmes. This review with updated data on prevalence, technical issues, cost of equipment and services for HMV should trigger objective dialogues between the stakeholders (patient associations, healthcare professionals and politicians); potentially leading to the production of workable strategies for the development of HMV in patients with NMD living in developing countries.
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Affiliation(s)
- Michel Toussaint
- Centre de Référence Neuromusculaire, Cliniques Universitaires de Bruxelles (ULB), Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
- Department of Neurology, Hospital Erasme, Brussels, Belgium
| | - Peter J Wijkstra
- Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Doug McKim
- CANVent Respiratory Services, Ottawa Hospital Respiratory Rehabilitation and The Ottawa Hospital Sleep Centre and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Joshua Benditt
- Respiratory Care Services, University of Washington Medical Center, Seattle, Washington, USA
| | | | - Jacek Nasiłowski
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Poland, Warsaw, Poland
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum. Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Jean-Christian Borel
- Sleep Laboratory and EFCR, Grenoble University Hospital, Grenoble Cedex 09, France
- R&D, AGIR a dom, Meylan, France
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22
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Kotanen P, Brander P, Kreivi HR. The prevalence of non-invasive ventilation and long-term oxygen treatment in Helsinki University Hospital area, Finland. BMC Pulm Med 2022; 22:248. [PMID: 35752824 PMCID: PMC9233351 DOI: 10.1186/s12890-022-02044-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic respiratory failure (CRF) can be treated at home with non-invasive ventilation (NIV) and/or long-term oxygen (LTOT). The prevalence of these treatments is largely unknown. We aimed to clarify the prevalence and indications of the treatments, and the three-year mortality of the treated patients in the Helsinki University Hospital (HUH) area in Finland. METHODS In this retrospective study we analyzed the prevalence of adult CRF patients treated with NIV and/or LTOT on 1.1.2018 and followed these patients until 1.1.2021. Data collected included the underlying diagnosis, patient characteristics, information on treatment initiation and from the last follow-up visit, and mortality during the three-year follow-up. Patients with home invasive mechanical ventilation or sleep apnea were excluded. RESULTS On 1.1.2018, we had a total of 815 patients treated with NIV and/or LTOT in the Helsinki University Hospital (HUH) area, with a population of 1.4 million. The prevalence of NIV was 35.4 per 100,000, of LTOT 24.6 per 100,000 and of the treatments combined 60.0 per 100,000. Almost half, 44.5%, were treated with NIV, 41.0% with LTOT, and 14.4% underwent both. The most common diagnostic groups were chronic obstructive pulmonary disease (COPD) (33.3%) and obesity-hypoventilation syndrome (OHS) (26.6%). The three-year mortality in all patients was 45.2%. In the COPD and OHS groups the mortality was 61.3% and 21.2%. In NIV treated patients, the treatment durations varied from COPD patients 5.3 years to restrictive chest wall disease patients 11.4 years. The age-adjusted Charlson co-morbidity index (ACCI) median for all patients was 3.0. CONCLUSIONS NIV and LTOT are common treatments in CRF. The prevalence in HUH area was comparable to other western countries. As the ACCI index shows, the treated patients were fragile, with multiple co-morbidities, and their mortality was high. Treatment duration and survival vary greatly depending on the underlying diagnosis.
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Affiliation(s)
- Petra Kotanen
- HUH Heart and Lung Center, University of Helsinki and Helsinki University Hospital, (Haartmaninkatu 4), P.O. Box 372, 00029, Helsinki, Finland. .,Doctoral Programme in Clinical Research, University of Helsinki, Helsinki, Finland.
| | - Pirkko Brander
- HUH Heart and Lung Center, University of Helsinki and Helsinki University Hospital, (Haartmaninkatu 4), P.O. Box 372, 00029, Helsinki, Finland
| | - Hanna-Riikka Kreivi
- HUH Heart and Lung Center, University of Helsinki and Helsinki University Hospital, (Haartmaninkatu 4), P.O. Box 372, 00029, Helsinki, Finland
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23
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Non-invasive ventilation in neuromuscular diseases: should we use higher levels of ventilatory support? Sleep Breath 2022; 27:673-677. [DOI: 10.1007/s11325-022-02658-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 10/18/2022]
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24
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Janssens JP, Cantero C, Pasquina P, Georges M, Rabec C. Monitoring Long Term Noninvasive Ventilation: Benefits, Caveats and Perspectives. Front Med (Lausanne) 2022; 9:874523. [PMID: 35665357 PMCID: PMC9160571 DOI: 10.3389/fmed.2022.874523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/26/2022] [Indexed: 12/03/2022] Open
Abstract
Long term noninvasive ventilation (LTNIV) is a recognized treatment for chronic hypercapnic respiratory failure (CHRF). COPD, obesity-hypoventilation syndrome, neuromuscular disorders, various restrictive disorders, and patients with sleep-disordered breathing are the major groups concerned. The purpose of this narrative review is to summarize current knowledge in the field of monitoring during home ventilation. LTNIV improves symptoms related to CHRF, diurnal and nocturnal blood gases, survival, and health-related quality of life. Initially, patients with LTNIV were most often followed through elective short in-hospital stays to ensure patient comfort, correction of daytime blood gases and nocturnal oxygenation, and control of nocturnal respiratory events. Because of the widespread use of LTNIV, elective in-hospital monitoring has become logistically problematic, time consuming, and costly. LTNIV devices presently have a built-in software which records compliance, leaks, tidal volume, minute ventilation, cycles triggered and cycled by the patient and provides detailed pressure and flow curves. Although the engineering behind this information is remarkable, the quality and reliability of certain signals may vary. Interpretation of the curves provided requires a certain level of training. Coupling ventilator software with nocturnal pulse oximetry or transcutaneous capnography performed at the patient's home can however provide important information and allow adjustments of ventilator settings thus potentially avoiding hospital admissions. Strategies have been described to combine different tools for optimal detection of an inefficient ventilation. Recent devices also allow adapting certain parameters at a distance (pressure support, expiratory positive airway pressure, back-up respiratory rate), thus allowing progressive changes in these settings for increased patient comfort and tolerance, and reducing the requirement for in-hospital titration. Because we live in a connected world, analyzing large groups of patients through treatment of “big data” will probably improve our knowledge of clinical pathways of our patients, and factors associated with treatment success or failure, adherence and efficacy. This approach provides a useful add-on to randomized controlled studies and allows generating hypotheses for better management of HMV.
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Affiliation(s)
- Jean-Paul Janssens
- Division of Pulmonary Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Hôpital de La Tour, Centre Cardio-Respiratoire, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- *Correspondence: Jean-Paul Janssens
| | - Chloé Cantero
- Service de Pneumologie, Hôpital Pitié-Salpêtrière AP-HP – Sorbonne Université, Paris, France
| | - Patrick Pasquina
- Division of Pulmonary Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Marjolaine Georges
- Pulmonary Department and Respiratory Critical Care Unit, University Hospital Dijon, Dijon, France
| | - Claudio Rabec
- Pulmonary Department and Respiratory Critical Care Unit, University Hospital Dijon, Dijon, France
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25
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Klingshirn H, Schwarz SB. [Quality of Care in Home Mechanical Ventilation]. Pneumologie 2022; 76:397-403. [PMID: 35588747 DOI: 10.1055/a-1803-2168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Home mechanical ventilation has developed rapidly over the last 20 years. Today's most common positive pressure ventilation can be performed either non-invasively via face masks or invasively via endotracheal intubation or tracheal cannula. Non-invasive ventilation (NIV) in particular has gained in importance in recent years as positive evidence for a variety of indications for home mechanical ventilation has become increasingly available. In order to ensure a high quality of treatment for the steadily increasing number of patients, specific guidelines for different patient groups have been developed and regularly updated. The appropriate care structures for these partly multimorbid patient cohorts are strongly discussed, since the capacity limits of the existing care structure are reached by the rapid development in home mechanical ventilation. This development shows, that a critical evaluation of the existing care structures is necessary in order to develop a patient-centered, customized and resource-saving healthcare structure on the basis of the existing structures and taking into account the national characteristics of the German healthcare system.
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Affiliation(s)
- Hanna Klingshirn
- Katholische Stiftungshochschule München, University of Applied Sciences, München
| | - Sarah B Schwarz
- Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Medizinische Fakultät, Universität Witten/Herdecke
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26
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Khonsari RH, Oranger M, François PM, Mendoza-Ruiz A, Leroux K, Boussaid G, Prieur D, Hodge JP, Belle A, Midler V, Morelot-Panzini C, Patout M, Gonzalez-Bermejo J. Quality versus emergency: How good were ventilation fittings produced by additive manufacturing to address shortages during the COVID19 pandemic? PLoS One 2022; 17:e0263808. [PMID: 35446853 PMCID: PMC9022824 DOI: 10.1371/journal.pone.0263808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/29/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The coronavirus disease pandemic (COVID-19) increased the risk of shortage in intensive care devices, including fittings with intentional leaks. 3D-printing has been used worldwide to produce missing devices. Here we provide key elements towards better quality control of 3D-printed ventilation fittings in a context of sanitary crisis. MATERIAL AND METHODS Five 3D-printed designs were assessed for non-intentional (junctional and parietal) and intentional leaks: 4 fittings 3D-printed in-house using FDeposition Modelling (FDM), 1 FDM 3D-printed fitting provided by an independent maker, and 2 fittings 3D-printed in-house using Polyjet technology. Five industrial models were included as controls. Two values of wall thickness and the use of coating were tested for in-house FDM-printed devices. RESULTS Industrial and Polyjet-printed fittings had no parietal and junctional leaks, and satisfactory intentional leaks. In-house FDM-printed fittings had constant parietal leaks without coating, but this post-treatment method was efficient in controlling parietal sealing, even in devices with thinner walls (0.7 mm vs 2.3 mm). Nevertheless, the use of coating systematically induced absent or insufficient intentional leaks. Junctional leaks were constant with FDM-printed fittings but could be controlled using rubber junctions rather than usual rigid junctions. The properties of Polyjet-printed and FDM-printed fittings were stable over a period of 18 months. CONCLUSIONS 3D-printing is a valid technology to produce ventilation devices but requires care in the choice of printing methods, raw materials, and post-treatment procedures. Even in a context of sanitary crisis, devices produced outside hospitals should be used only after professional quality control, with precise data available on printing protocols. The mechanical properties of ventilation devices are crucial for efficient ventilation, avoiding rebreathing of CO2, and preventing the dispersion of viral particles that can contaminate health professionals. Specific norms are still required to formalise quality control procedures for ventilation fittings, with the rise of 3D-printing initiatives and the perspective of new pandemics.
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Affiliation(s)
- Roman Hossein Khonsari
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker - Enfants Malades, Assistance Publique – Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
- Délégation Inter-Départementale pour le Développement de la Fabrication Additive (DIDDFA), Direction générale, Assistance Publique – Hôpitaux de Paris, Paris, France
- * E-mail:
| | - Mathilde Oranger
- Service de Réhabilitation Respiratoire (Département R3S), Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Sorbonne Université, Paris, France
| | | | | | | | - Ghilas Boussaid
- Service de Réhabilitation Respiratoire (Département R3S), Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Delphine Prieur
- Délégation Inter-Départementale pour le Développement de la Fabrication Additive (DIDDFA), Direction générale, Assistance Publique – Hôpitaux de Paris, Paris, France
| | | | - Antoine Belle
- Service de Pneumologie, Centre Hospitalier Intercommunal de Compiègne-Noyon, Compiègne, France
| | - Vincent Midler
- Département de la Maîtrise d’Ouvrage et de la Politique Technique – DEFIP, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Capucine Morelot-Panzini
- Faculté de Médecine, Sorbonne Université, Paris, France
- Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Paris, France
| | - Maxime Patout
- Faculté de Médecine, Sorbonne Université, Paris, France
- Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Paris, France
- Service des Pathologies du Sommeil (Département R3S), Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Jésus Gonzalez-Bermejo
- Service de Réhabilitation Respiratoire (Département R3S), Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Sorbonne Université, Paris, France
- Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Paris, France
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27
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Chung Y, Garden FL, Marks GB, Vedam H. Population Prevalence of Hypercapnic Respiratory Failure from Any Cause. Am J Respir Crit Care Med 2022; 205:966-967. [PMID: 35085057 DOI: 10.1164/rccm.202108-1912le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yewon Chung
- UNSW, 7800, South Western Sydney Clinical School, Sydney, New South Wales, Australia.,LIVERPOOL HOSPITAL, Respiratory and Sleep Medicine, Sydney, New South Wales, Australia.,Ingham Institute, 550242, Liverpool, New South Wales, Australia.,Maridulu Budyari Gumal (Sydney Partnership for Health, Education, Research and Enterprise), 4. Respiratory, Sleep, Environmental and Occupational Health Clinical Academic Group, Sydney, New South Wales, Australia;
| | - Frances L Garden
- UNSW, 7800, South Western Sydney Clinical School, Sydney, New South Wales, Australia.,Ingham Institute, 550242, Liverpool, New South Wales, Australia
| | - Guy B Marks
- UNSW, 7800, South Western Sydney Clinical School, Sydney, New South Wales, Australia.,LIVERPOOL HOSPITAL, Respiratory and Sleep Medicine, Sydney, New South Wales, Australia.,Ingham Institute, 550242, Liverpool, New South Wales, Australia.,Maridulu Budyari Gumal (Sydney Partnership for Health, Education, Research and Enterprise), 4. Respiratory, Sleep, Environmental and Occupational Health Clinical Academic Group, Sydney, New South Wales, Australia
| | - Hima Vedam
- UNSW, 7800, South Western Sydney Clinical School, Sydney, New South Wales, Australia.,LIVERPOOL HOSPITAL, Respiratory and Sleep Medicine, Sydney, New South Wales, Australia.,Ingham Institute, 550242, Liverpool, New South Wales, Australia.,Maridulu Budyari Gumal (Sydney Partnership for Health, Education, Research and Enterprise), 4. Respiratory, Sleep, Environmental and Occupational Health Clinical Academic Group, Sydney, New South Wales, Australia
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28
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Rabec C, Fresnel E, Rétory Y, Zhu K, Joly K, Kerfourn A, Dudoignon B, Mendoza A, Cuvelier A, Muir JF, Melloni B, Chabot JF, Gonzalez-Bermejo J, Patout M. Addition of bacterial filter alters positive airway pressure and non-invasive ventilation performances. Eur Respir J 2022; 59:13993003.02636-2021. [PMID: 35086835 PMCID: PMC9030068 DOI: 10.1183/13993003.02636-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/05/2022] [Indexed: 11/26/2022]
Abstract
Recently, one manufacturer of home ventilators issued an alert regarding the potential risk of serious injury related to the use of some of their positive airway pressure (PAP) and non-invasive ventilation (NIV) devices [1]. The risk is caused by the polyurethane foam used in their ventilators. In some cases, the foam broke into the blower and could have been inhaled by patients. The manufacturer and some healthcare regulatory agencies advocated, as a temporary solution, to modify PAP and NIV circuits by adding an inline bacterial filter in order to reduce the risk of inhalation [2]. However, changing ventilator circuits can alter ventilator performances during PAP and NIV [3]. The recommendation to add a bacterial filter on home positive pressure devices has significant negative impact on their performances and precludes auto-titrating positive airway pressure to function. These data suggest to not follow such recommendation.https://bit.ly/31YrWyo
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Affiliation(s)
- Claudio Rabec
- Pulmonary Department and Respiratory Critical Care Unit, University Hospital Dijon, Dijon, France.,Fédération ANTADIR, Paris, France.,Groupe Assistance Ventilatoire et O2 (GAVO2), Société de Pneumologie de Langue Française, Paris, France
| | | | - Yann Rétory
- Centre EXPLOR, Air Liquide Healthcare, Gentilly, France
| | - Kaixian Zhu
- Centre EXPLOR, Air Liquide Healthcare, Gentilly, France
| | | | | | - Benjamin Dudoignon
- 6AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France
| | - Alexis Mendoza
- Groupe Assistance Ventilatoire et O2 (GAVO2), Société de Pneumologie de Langue Française, Paris, France
| | - Antoine Cuvelier
- Normandie Univ, UNIRouen, EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France.,Groupe Assistance Ventilatoire et O2 (GAVO2), Société de Pneumologie de Langue Française, Paris, France
| | | | - Boris Melloni
- Fédération ANTADIR, Paris, France.,Pulmonary department, University Hospital Limoges, Limoges France
| | - Jean-François Chabot
- Fédération ANTADIR, Paris, France.,Département de Pneumologie, Université de Lorraine, CHU de Nancy, Vandœuvre-lès-Nancy, France
| | - Jésus Gonzalez-Bermejo
- Groupe Assistance Ventilatoire et O2 (GAVO2), Société de Pneumologie de Langue Française, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Maxime Patout
- Groupe Assistance Ventilatoire et O2 (GAVO2), Société de Pneumologie de Langue Française, Paris, France .,6AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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González J, Carmona P, Gracia-Lavedan E, Benítez ID, Antón A, Balaña A, Díaz SB, Bernadich Ò, Córdoba A, Embid C, Espallargues M, Luján M, Martí S, Castillo O, Del Pilar M, Tárrega J, Barbé F, Escarrabill J. Cluster analysis of home mechanical ventilation in copd patients: a picture of the real world and its impact on mortality. Arch Bronconeumol 2022; 58:642-648. [DOI: 10.1016/j.arbres.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/10/2021] [Accepted: 12/30/2021] [Indexed: 11/02/2022]
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30
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Martí S, Ferré A, Sampol G, Pallero M, Romero O, Ferrer J, Sampol J. Sleep increases leaks and asynchronies during home noninvasive ventilation: a polysomnographic study. J Clin Sleep Med 2022; 18:225-233. [PMID: 34314351 PMCID: PMC8807927 DOI: 10.5664/jcsm.9546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES In patients treated with noninvasive ventilation, sleep-related breathing changes can modify patient-ventilator interactions, which could reduce its effectiveness. The aim of this prospective observational study was to determine the impact of sleep/wake state on leaks, upper airway obstructive events, and asynchronies in patients treated by long-term noninvasive ventilation. METHODS Stable patients adapted to noninvasive ventilation were considered for nocturnal polysomnography. Unintentional leaks, upper airway obstructive events, and asynchronies were compared between sleep and awake periods. RESULTS Twenty-eight patients were enrolled. Underlying diagnoses were neuromuscular disease (n = 11), chest wall disease (n = 8), and obesity-hypoventilation (n = 9). Leaks were more frequent in sleep than in awake periods, with a median of 10% (interquartile range [IQR], 0%-75%) vs 1% (IQR, 0%-9%) of time (P < .001), respectively. During sleep, asynchronies with and without associated leak affected 27% of breaths (IQR, 16%-39%) compared with non-leak-related asynchronies that were recorded in 8% (IQR, 3%-25%) of breaths (P < .001). Asynchronies affecting more than 10% of total breaths were more frequent in sleep (25 patients, 89%) than in awake time (8 patients, 29%; P = .25). Eleven patients (39%) presented with 5 or more upper airway obstructive events without reduction in ventilatory drive per hour of sleep. CONCLUSIONS In patients adapted to home noninvasive ventilation, leaks, asynchronies, and upper airway obstructive events are frequent during the night and are concentrated in sleep periods. Asynchronies are often associated with leaks. These findings may have clinical implications considering that in patients with low sleep efficiency respiratory events could be underestimated if sleep is not evaluated. CITATION Martí S, Ferré A, Sampol G, et al. Sleep increases leaks and asynchronies during home noninvasive ventilation: a polysomnographic study. J Clin Sleep Med. 2022;18(1):225-233.
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Affiliation(s)
- Sergi Martí
- Respiratory Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain,CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain,Address correspondence to: Sergi Martí, MD, PhD, Respiratory Department, Hospital Universitari Vall d’Hebron, Passeig Vall d’Hebron, 119-129, 08035 Barcelona, Spain;
| | - Alex Ferré
- Sleep Unit, Hospital Universitari Vall d’Hebron, Barcelona, Spain,Neurophysiology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Gabriel Sampol
- Respiratory Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain,CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain,Sleep Unit, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Mercedes Pallero
- Respiratory Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain,CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Odile Romero
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain,Sleep Unit, Hospital Universitari Vall d’Hebron, Barcelona, Spain,Neurophysiology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Jaume Ferrer
- Respiratory Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain,CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Júlia Sampol
- Respiratory Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain,CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain,Sleep Unit, Hospital Universitari Vall d’Hebron, Barcelona, Spain
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31
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Home mechanical ventilatio: the Dutch approach. Pulmonology 2021; 28:99-104. [PMID: 34903502 DOI: 10.1016/j.pulmoe.2021.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/23/2022] Open
Abstract
In the Netherlands we have an unique organisation of only 4 centres being responsible for all patients who need Home Mechanical ventilation(HMV). Nationwide criteria for referral and initiation of HMV are stated in our national guideline and recently a unique national learning management system (LMS) for all caregivers and professionals was developed. A nationwide multi-centric research program is running and every centre is participating. In this paper we provide information about the evolution of HMV in the Netherlands during the last 30 years, including details about the number of patients, different diagnose groups, residence and the type of ventilators.
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32
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Maquilón C, Antolini M, Valdés N, Andrade M, Canales K, Rabec C, Olave C, Aguayo M, Rivas P, Andrade C, Venegas Á, Zapata S, Torres ME, Cabrera O, Villalobos J. Results of the home mechanical ventilation national program among adults in Chile between 2008 and 2017. BMC Pulm Med 2021; 21:394. [PMID: 34856963 PMCID: PMC8641152 DOI: 10.1186/s12890-021-01764-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background Home mechanical ventilation (HMV) is a viable and effective strategy for patients with chronic respiratory failure (CRF). The Chilean Ministry of Health started a program for adults in 2008. Methods This study examined the following data from a prospective cohort of patients with CRF admitted to the national HMV program: characteristics, mode of admission, quality of life, time in the program and survival. Results A total of 1105 patients were included. The median age was 59 years (44–58). Women accounted for 58.1% of the sample. The average body mass index (BMI) was 34.9 (26–46) kg/m2. A total of 76.2% of patients started HMV in the stable chronic mode, while 23.8% initiated HMV in the acute mode. A total of 99 patients were transferred from the children's program. There were 1047 patients on non-invasive ventilation and 58 patients on invasive ventilation. The median baseline PaCO2 level was 58.2 (52–65) mmHg. The device usage time was 7.3 h/d (5.8–8.8), and the time in HMV was 21.6 (12.2–49.5) months. The diagnoses were COPD (35%), obesity hypoventilation syndrome (OHS; 23.9%), neuromuscular disease (NMD; 16.3%), non-cystic fibrosis bronchiectasis or tuberculosis (non-CF BC or TBC; 8.3%), scoliosis (5.9%) and amyotrophic lateral sclerosis (ALS; 5.24%). The baseline score on the Severe Respiratory Insufficiency questionnaire (SRI) was 47 (± 17.9) points and significantly improved over time. The lowest 1- and 3-year survival rates were observed in the ALS group, and the lowest 9-year survival rate was observed in the non-CF BC or TB and COPD groups. The best survival rates at 9 years were OHS, scoliosis and NMD. In 2017, there were 701 patients in the children's program and 722 in the adult´s program, with a prevalence of 10.4 per 100,000 inhabitants. Conclusion The most common diagnoses were COPD and OHS. The best survival was observed in patients with OHS, scoliosis and NMD. The SRI score improved significantly in the follow-up of patients with HMV. The prevalence of HMV was 10.4 per 100,000 inhabitants. Trial registration This study was approved by and registered at the ethics committee of North Metropolitan Health Service of Santiago, Chile (N° 018/2021). Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01764-4.
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Affiliation(s)
- César Maquilón
- Department of Respiratory Diseases, Clínica Dávila, Recoleta 464, Building H, 6th floor, Santiago, Chile. .,Ministry of Health, AVNIA-AVIA Programs, Santiago, Chile.
| | - Mónica Antolini
- Department of Respiratory Diseases, Clínica Dávila, Recoleta 464, Building H, 6th floor, Santiago, Chile.,Ministry of Health, AVNIA-AVIA Programs, Santiago, Chile
| | - Nicolás Valdés
- School of Nursing and Obstetrics, Universidad de los Andes, Santiago, Chile
| | | | - Krishnna Canales
- Department of Respiratory Diseases, Clínica Dávila, Recoleta 464, Building H, 6th floor, Santiago, Chile.,Ministry of Health, AVNIA-AVIA Programs, Santiago, Chile
| | - Claudio Rabec
- Service de Pneumologie Et Soins Intensifs Respiratoires, CHU Dijon Bourgogne, Dijon, France
| | - Cristian Olave
- Ministry of Health, AVNIA-AVIA Programs, Santiago, Chile.,Instituto Nacional del Tórax, Santiago, Chile
| | - Miguel Aguayo
- Ministry of Health, AVNIA-AVIA Programs, Santiago, Chile
| | - Patricia Rivas
- Ministry of Health, AVNIA-AVIA Programs, Santiago, Chile
| | - Carmen Andrade
- Ministry of Health, AVNIA-AVIA Programs, Santiago, Chile
| | - Ángela Venegas
- Ministry of Health, AVNIA-AVIA Programs, Santiago, Chile
| | - Sandra Zapata
- Ministry of Health, AVNIA-AVIA Programs, Santiago, Chile
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Hill NS, Criner GJ, Branson RD, Celli BR, MacIntyre NR, Sergew A. Optimal NIV Medicare Access Promotion: Patients With COPD: A Technical Expert Panel Report From the American College of Chest Physicians, the American Association for Respiratory Care, the American Academy of Sleep Medicine, and the American Thoracic Society. Chest 2021; 160:e389-e397. [PMID: 34339684 PMCID: PMC8628175 DOI: 10.1016/j.chest.2021.06.082] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 11/29/2022] Open
Abstract
This document summarizes the work of the COPD Technical Expert Panel working group. For patients with COPD, the most pressing current coverage barriers identified were onerous diagnostic requirements focused on oxygenation (rather than ventilation) and difficulty obtaining bilevel devices with backup rate capabilities. Because of these difficulties, many patients with COPD were instead sometimes prescribed home mechanical ventilators. Critical evidence supports changes to current policies, including randomized controlled trial evidence suggesting a mortality benefit from bilevel positive airway pressure with backup rate and updated clinical practice guidelines from the American Thoracic Society as well as the European Respiratory Society. To achieve optimal access to noninvasive ventilation for patients with COPD, we make the following key recommendations: (1) removal of the need for overnight oximetry testing; (2) the ability to initiate therapy using bilevel devices with backup rate capability; and (3) increased duration of time to meet adherence criteria (ie, a second 90-day trial period) in those patients actively engaged in their care. Clear guidelines based on medical necessity are also included for patients who require initiation of or switch to a home mechanical ventilator. Adoption of these proposed recommendations would result in the right device, for the right type of patient with COPD, at the right time. Finally, we emphasize the need for adequate clinical support during initiation and maintenance of home noninvasive ventilation in such patients.
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Affiliation(s)
| | | | - Richard D Branson
- Division of Trauma, Critical Care & Acute Care Surgery, University of Cincinnati, Cincinnati, OH
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Schwarz SB, Mathes T, Majorski DS, Wollsching-Strobel M, Kroppen D, Magnet FS, Windisch W. Living conditions and autonomy levels in COPD patients receiving non-invasive ventilation: impact on health related quality of life. BMC Pulm Med 2021; 21:255. [PMID: 34344338 PMCID: PMC8330117 DOI: 10.1186/s12890-021-01621-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/07/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Research on health-related quality of life (HRQL) has become increasingly important in recent decades. However, the impact of both living conditions and the level of autonomy impairments on HRQL in COPD patients receiving non-invasive ventilation (NIV) is still unclear. METHODS The Severe Respiratory Insufficiency Questionnaire (SRI) was used to measure HRQL in a prospective cohort of COPD patients in whom home NIV was already established. Data on sociodemographics, clinical characteristics and standardized levels of autonomy impairment were evaluated. A multiple linear regression analysis was performed to identify the factors associated with a reduced HRQL. RESULTS A total of 137 patients (67.0 ± 7.8 years, 45% female) were assessed. The mean SRI Summary Score was 54.1 ± 16.9 (95%CI: 51.1-57.1; N = 127). Regular ambulatory care was provided in 76% of patients, but only 37% underwent pulmonary rehabilitation. Overall, 69% of patients lived with family members, while 31% lived alone (family situation). Autonomy impairment levels were most serious in 3%, serious in 14%, and significant in 29% of patients, while 54% had no impairments at all. Of note, higher levels of autonomy impairment were markedly associated with lower SRI scores (regression coefficient - 6.5 ± 1.1 per level; P < 0.001). In contrast, family situation (0.2 ± 3.0; P = 0.959), ambulatory care by a respiratory specialist (1.7 ± 3.6; P = 0.638), and pulmonary rehabilitation (- 0.8 ± 3.1; P = 0.802) did not appear to influence HRQL. Possible subgroup effects were evident for the factors "impaired autonomy" and "living in a nursing home" (P = 0.016). CONCLUSION A higher level of autonomy impairment has been identified as the major determinant of reduced HRQL in COPD-patients receiving long-term NIV, particularly in those living in a nursing home. Trial Registration German Clinical Trials Register (DRKS00008759).
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Affiliation(s)
- Sarah Bettina Schwarz
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine , Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Tim Mathes
- Institute for Research in Operative Medicine, Faculty of Health - School of Medicine, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Daniel Sebastian Majorski
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine , Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Maximilian Wollsching-Strobel
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine , Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Doreen Kroppen
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine , Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Friederike Sophie Magnet
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine , Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine , Ostmerheimer Strasse 200, 51109, Cologne, Germany.
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Ribeiro C, Vieira AL, Pamplona P, Drummond M, Seabra B, Ferreira D, Liberato H, Carreiro A, Vicente I, Castro L, Costa P, Carriço F, Martin T, Cravo J, Teixeira N, Grafino M, Conde S, Windisch W, Nunes R. Current Practices in Home Mechanical Ventilation for Chronic Obstructive Pulmonary Disease: A Real-Life Cross-Sectional Multicentric Study. Int J Chron Obstruct Pulmon Dis 2021; 16:2217-2226. [PMID: 34349507 PMCID: PMC8328383 DOI: 10.2147/copd.s314826] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/19/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Home mechanical ventilation (HMV) use in chronic obstructive pulmonary disease (COPD) is becoming increasingly widespread. The aim of this study was to provide an accurate description of the current practices and clinical characteristics of COPD patients on HMV in Portugal. Methods The study was designed as a cross-sectional, multicenter real-life study of COPD patients established on HMV for at least 30 days. Data related to clinical characteristics, adaptation and ventilatory settings were collected. Results The study included 569 COPD patients on HMV from 15 centers. The majority were male, with a median age of 72 years and a high prevalence of obesity (43.2%) and sleep apnea (45.8%). A high treatment compliance was observed (median 8h/day), 48.7% with inspiratory positive airway pressure ≥20 cmH2O and oronasal masks were the preferred interface (91.7%). There was an equal distribution of patients starting HMV during chronic stable condition and following an exacerbation. Patients in stable condition were initiated in the outpatient setting in 92.3%. Despite the differences in criteria and setting of adaptation and a slightly lower BMI in patients starting HMV following an exacerbation, we found no significant differences regarding age, gender, ventilation pressures, time on HMV, usage, severity of airflow obstruction or current arterial blood gas analysis (ABGs) in relation to patients adapted in stable condition. Conclusion Patients were highly compliant with the therapy. In agreement with most recent studies and recommendations, there seems to be a move towards higher ventilation pressures, increased use of oronasal masks and an intent to obtain normocapnia. This study shows that chronic hypercapnic and post exacerbation patients do not differ significantly regarding patient characteristics, physiological parameters or ventilatory settings with one exception: chronic hypercapnic patients are more often obese and, subsequently, more frequently present OSA.
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Affiliation(s)
- Carla Ribeiro
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - Paula Pamplona
- Pulmonology Department, Centro Hospitalar Universitário Lisboa Norte - Hospital Pulido Valente, Lisboa, Portugal
| | - Marta Drummond
- Centro de Responsabilidade Integrado Sono e VNI do Centro Hospitalar e Universitário São João, Porto, Portugal.,Faculty of Medicine, Porto University, Porto, Portugal
| | - Bárbara Seabra
- Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Diva Ferreira
- Pulmonology Department, Centro Hospitalar do Médio Ave, Famalicão, Portugal
| | - Hedi Liberato
- Pulmonology Department, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Alexandra Carreiro
- Pulmonology Department, Hospital do Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Portugal
| | - Inês Vicente
- Pulmonology Department, Centro Hospitalar Universitário da Cova da Beira, Covilhã, Portugal
| | - Luísa Castro
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal.,School of Health of Polytechnic of Porto, Porto, Portugal
| | - Pedro Costa
- Pulmonology Functional Unit, Unidade Local de Saúde do Norte Alentejano, Portalegre, Portugal
| | - Filipa Carriço
- Pulmonology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - Teresa Martin
- Pulmonology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - João Cravo
- Pulmonology Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Nélson Teixeira
- Pulmonology Department, Unidade Local de Saúde do Nordeste, Bragança, Portugal
| | - Mónica Grafino
- Pulmonology Department, Hospital da Luz, Lisboa, Portugal
| | - Sara Conde
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University, Cologne, Germany
| | - Rui Nunes
- Faculty of Medicine, Porto University, Porto, Portugal
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Jolly G, Razakamanantsoa L, Fresnel E, Gharsallaoui Z, Cuvelier A, Patout M. Defining successful non-invasive ventilation initiation: Data from a real-life cohort. Respirology 2021; 26:1067-1075. [PMID: 34312942 DOI: 10.1111/resp.14118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 05/31/2021] [Accepted: 07/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE When home non-invasive ventilation (NIV) is initiated, five goals need to be achieved: a daily use >4 h/day, an improvement in gas exchange, health-related quality of life (HRQL) and sleep quality without side effects. Our aim was to assess how frequently these five goals were reached and the factors predictive of achievement. METHODS We conducted a monocentric cohort study that included patients electively established on home NIV over 2 years. HRQL was assessed at baseline and follow-up by the Severe Respiratory Insufficiency questionnaire. Adequate initiation was defined as the achievement of at least three of five goals and successful initiation as the achievement of all. RESULTS Two-hundred and fifty patients were included at baseline. NIV was initiated for: obesity hypoventilation syndrome (n = 95; 38%), neuromuscular disease (n = 70; 28%), chronic obstructive pulmonary disease (n = 66; 26%) and chest wall disease (n = 19; 8%). At follow-up, measures of all five goals were available in 141 (56%) patients. NIV initiation was adequate for 96 (68%) patients and successful for 12 (9%) patients. In multivariate analysis, a tidal volume ≥ 7.8 ml/kg of ideal body weight was associated with an increased likelihood of adequate NIV initiation (hazard ratio: 5.765 [95% CI:1.824-18.223], p = 0.006]. Improvement in daytime partial arterial carbon dioxide pressure (PaCO2 ) was not correlated to improvement in HRQL or sleep quality. Severe to very severe NIV-related side effects occurred in 114 (47%) patients and were associated with higher daytime PaCO2 (6.35 ± 1.08 vs. 5.92 ± 0.79 kPa, p < 0.001). CONCLUSION Successful home NIV initiation is rarely achieved in real life. HRQL and NIV tolerance should be assessed to improve patient-centred outcomes.
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Affiliation(s)
- Grégoire Jolly
- Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, Rouen University Hospital, Rouen University, Rouen, France
| | - Léa Razakamanantsoa
- Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, Rouen University Hospital, Rouen University, Rouen, France.,Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIRouen, Rouen, France
| | | | - Zouhaier Gharsallaoui
- Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, Rouen University Hospital, Rouen University, Rouen, France
| | - Antoine Cuvelier
- Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, Rouen University Hospital, Rouen University, Rouen, France.,Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIRouen, Rouen, France
| | - Maxime Patout
- Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIRouen, Rouen, France.,Service des Pathologies du Sommeil (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France.,URMS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, Paris, France
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Schwarz SB, Wollsching-Strobel M, Majorski DS, Magnet FS, Mathes T, Windisch W. [Invasive and Non-Invasive Home Mechanical Ventilation in Germany - A Rapid Development with Large Regional Differences]. Pneumologie 2021; 75:942-949. [PMID: 34171929 DOI: 10.1055/a-1509-7014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The number of patients using home mechanical ventilation (HMV) is steadily increasing in Germany. Detailed data on inpatient initiation and control of HMV are not available. This, however, is absolutely necessary in order to optimize the medical care structures in Germany. Regional diversities must be taken into consideration in order to provide care structures that reflect the local needs. METHOD The data sets of the German Federal Statistical Office on the OPS (Operation and Procedure Classification System) for HMV from 2008 to 2019 were analysed (N = 572,494). RESULTS Between 2008 and 2019 there was a doubling of the number of HMV initiations and controls. The number of initiations (N = 17,958) and controls (N = 49,140) was highest in 2019. Furthermore, at the state level, the development of HMV is very heterogeneous. Finally, the increases were particularly due to an increase in non-invasively ventilated patients. CONCLUSION The rapid increase in HMV is reaching capacity limits of the existing healthcare structure. New healthcare structures should provide an integrated approach between outpatient and inpatient care in order to ensure a high quality of care for patients receiving HMV without compromising the human and economic resources of the system.
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Affiliation(s)
- Sarah Bettina Schwarz
- Lungenklinik Merheim, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | | | | | - Friederike Sophie Magnet
- Lungenklinik Merheim, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Tim Mathes
- IFOM - Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Wolfram Windisch
- Lungenklinik Merheim, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
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Cantero C, Pasquina P, Dao MD, Cedraschi C, Adler D, Plojoux J, Janssens JP. Impact of Confinement in Patients under Long-Term Noninvasive Ventilation during the First Wave of the SARS-CoV-2 Pandemic: A Remarkable Resilience. Respiration 2021; 100:909-917. [PMID: 34130277 PMCID: PMC8339039 DOI: 10.1159/000516327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/22/2021] [Indexed: 01/13/2023] Open
Abstract
Background During the first wave of the SARS-CoV-2 pandemic in Switzerland, confinement was imposed to limit transmission and protect vulnerable persons. These measures may have had a negative impact on perceived quality of care and symptoms in patients with chronic disorders. Objectives To determine whether patients under long-term home noninvasive ventilation (LTHNIV) for chronic respiratory failure (CRF) were negatively affected by the 56-day confinement (March–April 2020). Methods A questionnaire-based survey exploring mood disturbances (HAD), symptom scores related to NIV (S<sup>3</sup>-NIV), and perception of health-care providers during confinement was sent to all patients under LTHNIV followed up by our center. Symptom scores and data obtained by ventilator software were compared between confinement and the 56 days prior to confinement. Results Of a total of 100 eligible patients, 66 were included (median age: 66 years [IQR: 53–74]): 35 (53%) with restrictive lung disorders, 20 (30%) with OHS or SRBD, and 11 (17%) with COPD or overlap syndrome. Prevalence of anxiety (n = 7; 11%) and depressive (n = 2; 3%) disorders was remarkably low. Symptom scores were slightly higher during confinement although this difference was not clinically relevant. Technical data regarding ventilation, including compliance, did not change. Patients complained of isolation and lack of social contact. They felt supported by their relatives and caregivers but complained of the lack of regular contact and information by health-care professionals. Conclusions Patients under LTHNIV for CRF showed a remarkable resilience during the SARS-CoV-2 confinement period. Comments provided may be helpful for managing similar future health-care crises.
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Affiliation(s)
- Chloé Cantero
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Patrick Pasquina
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Melissa Dominicé Dao
- Division of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Christine Cedraschi
- Division of General Medical Rehabilitation and Multidisciplinary Pain Center, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Dan Adler
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Jérôme Plojoux
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
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Pierucci P, Crimi C, Carlucci A, Carpagnano GE, Janssens JP, Lujan M, Noto A, Wijkstra PJ, Windisch W, Scala R. REINVENT: ERS International survey on REstrictive thoracic diseases IN long term home noninvasive VENTilation. ERJ Open Res 2021; 7:00911-2020. [PMID: 33898619 PMCID: PMC8053911 DOI: 10.1183/23120541.00911-2020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background and aim Little is known about the current use of long-term home noninvasive ventilation (LTHNIV) in restrictive thoracic diseases, including chest wall disorders and neuromuscular disorders (NMD). This study aimed to capture the pattern of LTHNIV in patients with restrictive thoracic diseases via a web-based international survey. Methods The survey involved European Respiratory Society (ERS) Assembly 2.02 (NIV-dedicated group), from October to December 2019. Results 166 (22.2%) out of 748 members from 41 countries responded; 80% were physicians, of whom 43% worked in a respiratory intermediate intensive care unit. The ratio of NMD to chest wall disorders was 5:1, with amyotrophic lateral sclerosis the most frequent indication within NMD (78%). The main reason to initiate LTHNIV was diurnal hypercapnia (71%). Quality of life/sleep was the most important goal to achieve. In 25% of cases, clinicians based their choice of the ventilator on patients' feedback. Among NIV modes, spontaneous-timed pressure support ventilation (ST-PSV) was the most frequently prescribed for day- and night-time. Mouthpieces were the preferred daytime NIV interface, whereas oro-nasal masks the first choice overnight. Heated humidification was frequently added to LTHNIV (72%). Single-limb circuits with intentional leaks (79%) were the most frequently prescribed. Follow-up was most often provided in an outpatient setting. Conclusions This ERS survey illustrates physicians' practices of LTHNIV in patients with restrictive thoracic diseases. NMD and, specifically, amyotrophic lateral sclerosis were the main indications for LTHNIV. NIV was started mostly because of diurnal hypoventilation with a primary goal of patient-centred benefits. Bi-level ST-PSV and oro-nasal masks were more likely to be chosen for providing NIV. LTHNIV efficacy was assessed mainly in an outpatient setting.
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Affiliation(s)
- Paola Pierucci
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy.,"Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, "Policlinico-Vittorio Emanuele San Marco" University Hospital, Catania, Italy
| | - Annalisa Carlucci
- Reparto Pneumologia Riabilitativa Istituti Clinici Scientifici Maugeri Pavia, Pavia, Italy.,Dipartimento di Medicina e Chirurgia, Università Insubria Varese-Como, Varese, Italy
| | - Giovanna E Carpagnano
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy.,"Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Manel Lujan
- Pneumology Service, Hospital Universitari Parc Taulí de Sabadell, Universitat Autònoma de Barcelona, CIBERES, Sabadell, Spain
| | - Alberto Noto
- Dept of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Division of Anesthesia and Intensive Care, University of Messina, Policlinico "G. Martino", Messina, Italy.,IPCF-CNR, Institute for Chemical and Physical Processes, National Research Council, Messina, Italy
| | - Peter J Wijkstra
- Dept of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Wolfram Windisch
- Cologne Merheim Hospital, Dept of Pneumology, Kliniken der Stadt Köln; gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S Donato Hospital, Arezzo, Italy
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Lebret M, Léotard A, Pépin JL, Windisch W, Ekkernkamp E, Pallero M, Sánchez-Quiroga MÁ, Hart N, Kelly JL, Patout M, Funk GC, Duiverman ML, Masa JF, Simonds A, Murphy PB, Wijkstra PJ, Dreher M, Storre J, Khouri C, Borel JC. Nasal versus oronasal masks for home non-invasive ventilation in patients with chronic hypercapnia: a systematic review and individual participant data meta-analysis. Thorax 2021; 76:1108-1116. [PMID: 33859049 DOI: 10.1136/thoraxjnl-2020-215613] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 01/31/2021] [Accepted: 03/12/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The optimal interface for the delivery of home non-invasive ventilation (NIV) to treat chronic respiratory failure has not yet been determined. The aim of this individual participant data (IPD) meta-analysis was to compare the effect of nasal and oronasal masks on treatment efficacy and adherence in patients with COPD and obesity hypoventilation syndrome (OHS). METHODS We searched Medline and Cochrane Central Register of Controlled Trials for prospective randomised controlled trials (RCTs) of at least 1 month's duration, published between January 1994 and April 2019, that assessed NIV efficacy in patients with OHS and COPD. The main outcomes were diurnal PaCO2, PaO2 and NIV adherence (PROSPERO CRD42019132398). FINDINGS Of 1576 articles identified, 34 RCTs met the inclusion criteria and IPD were obtained for 18. Ten RCTs were excluded because only one type of mask was used, or mask data were missing. Data from 8 RCTs, including 290 IPD, underwent meta-analysis. Oronasal masks were used in 86% of cases. There were no differences between oronasal and nasal masks for PaCO2 (0.61 mm Hg (95% CI -2.15 to 3.38); p=0.68), PaO2 (-0.00 mm Hg (95% CI -4.59 to 4.58); p=1) or NIV adherence (0·29 hour/day (95% CI -0.74 to 1.32); p=0.58). There was no interaction between the underlying pathology and the effect of mask type on any outcome. INTERPRETATION Oronasal masks are the most used interface for the delivery of home NIV in patients with OHS and COPD; however, there is no difference in the efficacy or tolerance of oronasal or nasal masks.
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Affiliation(s)
- Marius Lebret
- Pneumology Department, Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, Quebec, Canada
| | | | - Jean Louis Pépin
- HP2 Laboratory INSERM U1042, Univ. Grenoble Alpes, Grenoble, France
| | - Wolfram Windisch
- Department of Pneumology and Critical Care Medicine, Cologne Merheim Hospital, Cologne, Germany.,Depatment of Pneumology, Kliniken der Stadt Köln gGmbH, Cologne, Germany.,Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Emelie Ekkernkamp
- Department of Pneumology, University Hospital Freiburg, Freiburg, Germany
| | - Mercedes Pallero
- Respiratory Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Nicholas Hart
- Lane Fox Respiratory Service, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Julia L Kelly
- NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Maxime Patout
- Departement of pneumology and intensive care, University Hospital, Rouen, France
| | - Georg Chistian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Marieke L Duiverman
- Pulmonary Diseases and Home Mechanical Ventilation, University Medical Centre Groningen, Groningen, Netherlands
| | - Juan F Masa
- San Pedro de Alcantara Hospital, Caceres, Spain
| | - Anita Simonds
- National Institute of Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Respiratory Medicine, Imperial College London, London, UK
| | | | - Peter J Wijkstra
- Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Michael Dreher
- Pneumology and Intensive Care Medicine, Universitatsklinikum Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Jan Storre
- Pneumology Department, University Medical Center Freiburg, Freiburg, Germany.,Praxis Pneumologie Solln, Munich, Germany
| | - Charles Khouri
- HP2 Laboratory INSERM 1042, Grenoble Universites, Saint-Martin-d'Heres, France
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Spurr L. The treatment burden of long-term home noninvasive ventilation. Breathe (Sheff) 2021; 17:200291. [PMID: 34295400 PMCID: PMC8291946 DOI: 10.1183/20734735.0291-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 11/18/2022] Open
Abstract
The prevalence of long-term home noninvasive ventilation (NIV) has progressively increased over recent decades, supported by evidence of clinical effectiveness in a range of conditions leading to chronic respiratory failure [1, 2]. Simultaneous technological developments have improved the reliability, portability, and comfort of devices, making NIV increasingly accessible and acceptable as a treatment option [3]. Clinicians are usually fully cognisant of the clinical outcomes they anticipate when recommending or initiating long-term NIV, for example prolonging life, preventing complications or healthcare utilisation, and/or improving symptoms. The evidence on key clinical outcomes is variable between conditions but is comprehensively evaluated in relevant clinical guidelines; traditionally less emphasis is placed on the potential practical and psychosocial implications of domiciliary NIV. However, the preferences, values and resources of individuals can have a significant impact on NIV usage and therefore may affect potential clinical benefit. This editorial discusses the healthcare-associated workload, also known as the treatment burden, of domiciliary NIV that may be shouldered by patients, their families and caregivers, justifying why the cost/benefit ratio must be carefully considered on an individual basis. Long-term home noninvasive ventilation has practical and psychosocial implications for individuals, families and caregivers. Exploring the impact of the workload of healthcare or “treatment burden” helps determine treatment feasibility and acceptability.https://bit.ly/39YUY2A
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Affiliation(s)
- Lydia Spurr
- Academic and Clinical Dept of Sleep and Breathing, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
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42
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Delorme M, Leroux K, Boussaid G, Lebret M, Prigent H, Leotard A, Louis B, Lofaso F. Protective Recommendations for Non-invasive Ventilation During COVID-19 Pandemic: A Bench Evaluation of the Effects of Instrumental Dead Space on Alveolar Ventilation. Arch Bronconeumol 2021; 57:28-33. [PMID: 34629640 PMCID: PMC8046339 DOI: 10.1016/j.arbres.2021.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/02/2021] [Indexed: 12/14/2022]
Abstract
Introduction With the current COVID-19 pandemic, concerns have raised regarding the risk for NIV to promote airborne transmission. In case of hospital admission, continuation of therapy in patients undergoing chronic NIV is necessary and several protective circuit configurations have been recommended to reduce the risk of aerosol dissemination. However, all these configurations increase instrumental dead space. We therefore designed this study to evaluate their effects on the tidal volume (VTE) required to preserve stable end-tidal CO2 partial pressure (PETCO2) with constant respiratory rate. Methods A bench consisting of a test lung connected to an adult-sized mannequin head was set up. The model was ventilated through usual domiciliary configuration (single limb circuit with facial vented mask) which was used as reference. Then, five different circuit configurations including non-vented facial mask with viral/bacterial filter, modification of leak position, and change from single to double-limb circuit were evaluated. For each configuration, pressure support (PS) was gradually increased to reach reference PETCO2. Resulting VTE was recorded as primary outcome. Results Reference PETCO2 was 38(0) mmHg, with a PS set at 10 cmH2O, resulting in a VTE of 432(2) mL. Compared to reference, all the configurations evaluated required substantial increase in VTE to preserve alveolar ventilation, ranging from +79(2) to +216(1) mL. Conclusions Modifications of NIV configurations in the context of COVID-19 pandemic result in substantial increase of instrumental dead space. Re-evaluation of treatment efficiency and settings is crucial whenever protective measures influencing NIV equipment are considered.
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Affiliation(s)
- Mathieu Delorme
- Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France.
| | | | - Ghilas Boussaid
- Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France
| | - Marius Lebret
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Québec, QC, Canada
| | - Helene Prigent
- Service de Physiologie - Explorations Fonctionnelles, Unité des Pathologies du Sommeil, AP-HP, Hôpital Raymond Poincaré, 92380 Garches, France; Université Paris-Saclay, UVSQ, INSERM U1179, Equipe 3, 78000 Versailles, France
| | - Antoine Leotard
- Service de Physiologie - Explorations Fonctionnelles, Unité des Pathologies du Sommeil, AP-HP, Hôpital Raymond Poincaré, 92380 Garches, France; Université Paris-Saclay, UVSQ, INSERM U1179, Equipe 3, 78000 Versailles, France
| | - Bruno Louis
- INSERM, U955, Université Paris Est Créteil, Faculté de Médecine, CNRS ERL 7000, 94010 Créteil, France
| | - Frédéric Lofaso
- Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France; Service de Physiologie - Explorations Fonctionnelles, Unité des Pathologies du Sommeil, AP-HP, Hôpital Raymond Poincaré, 92380 Garches, France
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43
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Majorski DS, Duiverman ML, Windisch W, Schwarz SB. Long-term noninvasive ventilation in COPD: current evidence and future directions. Expert Rev Respir Med 2021; 15:89-101. [PMID: 33245003 DOI: 10.1080/17476348.2021.1851601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Long-term noninvasive ventilation (NIV) is an established treatment for end-stage COPD patients suffering from chronic hypercapnic respiratory failure. This is reflected by its prominent position in national and international medical guidelines. Areas covered: In recent years, novel developments in technology such as auto-titrating machines and hybrid modes have emerged, and when combined with advances in information and communication technologies, these developments have served to improve the level of NIV-based care. Such progress has largely been instigated by the fact that healthcare systems are now confronted with an increase in the number of patients, which has led to the need for a change in current infrastructures. This article discusses the current practices and recent trends, and offers a glimpse into the future possibilities and requirements associated with this form of ventilation therapy. Expert opinion: Noninvasive ventilation is an established and increasingly used treatment option for patients with chronic hypercapnic COPD and those with persistent hypercapnia following acute hypercapnic lung failure. The main target is to augment alveolar hypoventilation by reducing PaCO2 to relieve symptoms. Nevertheless, when dealing with severely impaired patients, it appears necessary to switch the focus to patient-related outcomes such as health-related quality of life.
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Affiliation(s)
- Daniel S Majorski
- Department of Pneumology, Cologne Merheim Hospital , Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University , Witten, Germany
| | - Marieke L Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital , Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University , Witten, Germany
| | - Sarah B Schwarz
- Department of Pneumology, Cologne Merheim Hospital , Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University , Witten, Germany
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Ribeiro C, Conde S, Oliveira P, Nogueira C, Ferreira D, Adler D, Windisch W, Nunes R. Portuguese adaptation of the S3-non-invasive ventilation (S3-NIV) questionnaire for home mechanically ventilated patients. Pulmonology 2020; 28:262-267. [PMID: 33388296 DOI: 10.1016/j.pulmoe.2020.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/31/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022] Open
Abstract
Short, valid and easy to use tools are needed to monitor non-invasive ventilation in clinical practice and for organization of home mechanical ventilation services. The aim of this study was to develop a professional translation and cultural adaptation of the Portuguese S3 non-invasive ventilation questionnaire. 234 stable patients (128 male patients, 53.8%) with a mean age of 69.3 years under long-term home non-invasive ventilation were recruited from a single-center outpatient clinic. The most frequent diagnostic groups were obesity hypoventilation syndrome, chronic obstructive pulmonary disease and restrictive chest wall disorders. The Portuguese version of the questionnaire was obtained using translation back-translation process with two professional translators. Internal consistency for the total score was good (Cronbach's α coefficient of 0.76) as well as for the "respiratory symptoms" and the "sleep and side effects" domains (Cronbach's α coefficient=0.68 and Cronbach's α coefficient=0.72, respectively). An exploratory factor analysis was performed leading to an explained variance of 54.6%, and resulted in 3 components. The Portuguese version of the S3-NIV questionnaire is a simple and valid tool for the routine clinical assessment of patients receiving home NIV.
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Affiliation(s)
- C Ribeiro
- Serviço de Pneumologia - Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal.
| | - S Conde
- Serviço de Pneumologia - Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - P Oliveira
- ISPUP-EPIUnit, Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal
| | - C Nogueira
- Serviço de Pneumologia - Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - D Ferreira
- Serviço de Pneumologia - Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - D Adler
- Division of Lung Diseases, Geneva University Hospitals, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland
| | - W Windisch
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
| | - R Nunes
- Faculdade de Medicina da Universidade do Porto, Portugal
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45
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Janssens JP, Michel F, Schwarz EI, Prella M, Bloch K, Adler D, Brill AK, Geenens A, Karrer W, Ogna A, Ott S, Rüdiger J, Schoch OD, Soler M, Strobel W, Uldry C, Gex G. Long-Term Mechanical Ventilation: Recommendations of the Swiss Society of Pulmonology. Respiration 2020; 99:1-36. [PMID: 33302274 DOI: 10.1159/000510086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022] Open
Abstract
Long-term mechanical ventilation is a well-established treatment for chronic hypercapnic respiratory failure (CHRF). It is aimed at improving CHRF-related symptoms, health-related quality of life, survival, and decreasing hospital admissions. In Switzerland, long-term mechanical ventilation has been increasingly used since the 1980s in hospital and home care settings. Over the years, its application has considerably expanded with accumulating evidence of beneficial effects in a broad range of conditions associated with CHRF. Most frequent indications for long-term mechanical ventilation are chronic obstructive pulmonary disease, obesity hypoventilation syndrome, neuromuscular and chest wall diseases. In the current consensus document, the Special Interest Group of the Swiss Society of Pulmonology reviews the most recent scientific literature on long-term mechanical ventilation and provides recommendations adapted to the particular setting of the Swiss healthcare system with a focus on the practice of non-invasive and invasive home ventilation in adults.
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Affiliation(s)
- Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland,
| | - Franz Michel
- Klinik für Neurorehabilitation und Paraplegiologie, Basel, Switzerland
| | - Esther Irene Schwarz
- Department of Pulmonology and Sleep Disorders Centre, University Hospital of Zurich, Zurich, Switzerland
| | - Maura Prella
- Division of Pulmonary Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Konrad Bloch
- Department of Pulmonology and Sleep Disorders Centre, University Hospital of Zurich, Zurich, Switzerland
| | - Dan Adler
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | | | - Aurore Geenens
- Pulmonary League of the Canton of Vaud, Lausanne, Switzerland
| | | | - Adam Ogna
- Respiratory Medicine Service, Locarno Regional Hospital, Locarno, Switzerland
| | - Sebastien Ott
- Universitätsklinik für Pneumologie, Universitätsspital (Inselspital) und Universität, Bern, Switzerland
- Division of Pulmonary Diseases, St. Claraspital, Basel, Switzerland
| | - Jochen Rüdiger
- Division of Pulmonary and Sleep Medicine, Medizin Stollturm, Münchenstein, Switzerland
| | - Otto D Schoch
- Division of Pulmonary Diseases, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Markus Soler
- Division of Pulmonary Diseases, St. Claraspital, Basel, Switzerland
| | - Werner Strobel
- Division of Pulmonary Diseases, Universitätsspital Basel, Basel, Switzerland
| | - Christophe Uldry
- Division of Pulmonary Diseases and Pulmonary Rehabilitation Center, Rolle Hospital, Rolle, Switzerland
| | - Grégoire Gex
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Pulmonary Diseases, Hôpital du Valais, Sion, Switzerland
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46
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Georges M, Rabec C, Monin E, Aho S, Beltramo G, Janssens JP, Bonniaud P. Monitoring of noninvasive ventilation: comparative analysis of different strategies. Respir Res 2020; 21:324. [PMID: 33302961 PMCID: PMC7725884 DOI: 10.1186/s12931-020-01586-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 11/24/2020] [Indexed: 12/14/2022] Open
Abstract
Background Noninvasive ventilation (NIV) represents an effective treatment for chronic respiratory failure. However, empirically determined NIV settings may not achieve optimal ventilatory support. Therefore, the efficacy of NIV should be systematically monitored. The minimal recommended monitoring strategy includes clinical assessment, arterial blood gases (ABG) and nocturnal transcutaneous pulsed oxygen saturation (SpO2). Polysomnography is a theoretical gold standard but is not routinely available in many centers. Simple tools such as transcutaneous capnography (TcPCO2) or ventilator built-in software provide reliable informations but their role in NIV monitoring has yet to be defined. The aim of our work was to compare the accuracy of different combinations of tests to assess NIV efficacy. Methods This retrospective comparative study evaluated the efficacy of NIV in consecutive patients through four strategies (A, B, C and D) using four different tools in various combinations. These tools included morning ABG, nocturnal SpO2, TcPCO2 and data provided by built-in software via a dedicated module. Strategy A (ABG + nocturnal SpO2), B (nocturnal SpO2 + TcPCO2) and C (TcPCO2 + builtin software) were compared to strategy D, which combined all four tools (NIV was appropriate if all four tools were normal). Results NIV was appropriate in only 29 of the 100 included patients. Strategy A considered 53 patients as appropriately ventilated. Strategy B considered 48 patients as appropriately ventilated. Strategy C misclassified only 6 patients with daytime hypercapnia. Conclusion Monitoring ABG and nocturnal SpO2 is not enough to assess NIV efficacy. Combining data from ventilator built-in software and TcPCO2 seems to represent the best strategy to detect poor NIV efficacy. Trialregistration Institutional Review Board of the Société de Pneumologie de Langue Française (CEPRO 2016 Georges)
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Affiliation(s)
- Marjolaine Georges
- Department of Pulmonary Medicine and Intensive Care Unit, University Hospital, Dijon, France. .,University Burgundy Franche-Comté, Dijon, France. .,Centre Des Sciences du Goût Et de L'Alimentation, UMR 6265 CNRS 1234 INRA, University Burgundy Franche-Comté, Dijon, France. .,Service de Pneumologie Et Soins Intensifs Respiratoires, Centre Hospitalier Et Universitaire de Dijon, Hôpital François Mitterrand, 14 rue Paul Gaffarel, 21079, Dijon, France.
| | - Claudio Rabec
- Department of Pulmonary Medicine and Intensive Care Unit, University Hospital, Dijon, France
| | - Elise Monin
- Department of Pulmonary Medicine and Intensive Care Unit, University Hospital, Dijon, France
| | - Serge Aho
- University Burgundy Franche-Comté, Dijon, France.,Department of Epidemiology, Dijon University Hospital, Dijon, France
| | - Guillaume Beltramo
- Department of Pulmonary Medicine and Intensive Care Unit, University Hospital, Dijon, France
| | - Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Philippe Bonniaud
- Department of Pulmonary Medicine and Intensive Care Unit, University Hospital, Dijon, France.,University Burgundy Franche-Comté, Dijon, France.,INSERM U1231, University Burgundy Franche-Comté, Dijon, France
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Cantero C, Adler D, Pasquina P, Uldry C, Egger B, Prella M, Younossian AB, Soccal-Gasche P, Pépin JL, Janssens JP. Long-Term Non-invasive Ventilation: Do Patients Aged Over 75 Years Differ From Younger Adults? Front Med (Lausanne) 2020; 7:556218. [PMID: 33262990 PMCID: PMC7686650 DOI: 10.3389/fmed.2020.556218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/22/2020] [Indexed: 12/05/2022] Open
Abstract
Background: Noninvasive ventilation (NIV) is accepted as standard of care for chronic hypercapnic respiratory failure (CHRF) and is being increasingly implemented in older subjects. However, little is known regarding the use of NIV on a long-term basis in the very old. The outcomes of this study were: 1/to report the proportion of patients ≥ 75 years old (elderly) among a large group of long-term NIV users and its trend since 2000; 2/to compare this population to a younger population (<75 years old) under long-term NIV in terms of diagnoses, comorbidities, anthropometric data, technical aspects, adherence to and efficiency of NIV. Methods: In a cross-sectional analysis of a multicenter cohort study on patients with CHRF under NIV, diagnoses, comorbidities, technical aspects, adherence to and efficiency of NIV were compared between patients ≥ 75 and <75 years old (chi-square or Welch Student tests). Results: Of a total of 489 patients under NIV, 151 patients (31%) were ≥ 75 years of age. Comorbidities such as systemic hypertension (86 vs. 60%, p < 0.001), chronic heart failure (30 vs. 18%, p = 0.005), and pulmonary hypertension (25 vs. 14%, p = 0.005) were more frequent in older subjects. In the older group, there was a trend for a higher prevalence of chronic obstructive pulmonary disease (COPD) (46 vs. 36%, p = 0.151) and a lower prevalence of neuromuscular diseases (NMD) (19 vs. 11%, p = 0.151), although not significant. Adherence to and efficacy of NIV were similar in both groups (daily use of ventilator: 437 vs. 419 min, p = 0.76; PaCO2: 5.8 vs. 5.9 kPa, p = 0.968). Unintentional leaks were slightly higher in the older group (1.8 vs. 0.6 L/min, p = 0.018). Conclusions: In this cross-sectional study, one third of the population under NIV was ≥ 75 years old. Markers of efficacy of NIV, and adherence to treatment were similar when compared to younger subjects, confirming the feasibility of long-term NIV in the very old. Health-related quality of life was not assessed in this study and further research is needed to address this issue.
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Affiliation(s)
- Chloé Cantero
- Division of Pulmonary Diseases, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Dan Adler
- Division of Pulmonary Diseases, Geneva University Hospitals (HUG), Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Patrick Pasquina
- Division of Pulmonary Diseases, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Christophe Uldry
- Division of Pulmonary Diseases and Pulmonary Rehabilitation Center, Rolle Hospital Rolle, Vaud, Switzerland
| | - Bernard Egger
- Division of Pulmonary Diseases and Pulmonary Rehabilitation Center, Rolle Hospital Rolle, Vaud, Switzerland
| | - Maura Prella
- Division of Pulmonary Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Alain Bigin Younossian
- Division of Pulmonary Diseases and Intensive Care, La Tour Hospital, Geneva, Switzerland
| | - Paola Soccal-Gasche
- Division of Pulmonary Diseases, Geneva University Hospitals (HUG), Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean-Louis Pépin
- HP2 Laboratory, Inserm U1042 Unit, University Grenoble Alps, Grenoble, France.,EFCR Laboratory, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France
| | - Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospitals (HUG), Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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48
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Wijkstra P, Duiverman M. Home Mechanical Ventilation: A Fast-Growing Treatment Option in Chronic Respiratory Failure. Chest 2020; 158:26-27. [PMID: 32654706 DOI: 10.1016/j.chest.2020.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/16/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Peter Wijkstra
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
| | - Marieke Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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49
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Martinez-García MA, Villa C, Dobarganes Y, Girón R, Maíz L, García-Clemente M, Sibila O, Golpe R, Rodríguez J, Barreiro E, Rodriguez JL, Menéndez R, Prados C, de la Rosa D, Olveira C. RIBRON: The spanish Online Bronchiectasis Registry. Characterization of the First 1912 Patients. Arch Bronconeumol 2020; 57:28-35. [PMID: 32081438 DOI: 10.1016/j.arbres.2019.12.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/15/2019] [Accepted: 12/15/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The SEPAR Spanish Bronchiectasis Registry (RIBRON) began as a platform for the collection of longitudinal data on patients with this disease. The objective of this study is to describe its operation and to analyze the characteristics of bronchiectasis patients according to sex. METHODS A total of 1912 adult patients diagnosed with bronchiectasis in 43 centers were included between February 2015 and 2019. All patients had complete data consisting of at least 79 basic required variables, controlled by an external audit. RESULTS Mean age was 67.6 (15.2) years; 63.9% were women. The most common symptom was productive cough (78.3%) which was mucopurulent-purulent in 45.9% of cases. The most common etiology was post-infectious (40.4%), while 18.5% were idiopathic. Pseudomonas aeruginosa was the most frequently isolated microorganism (40.4%), of which 25.6% were associated with chronic infection. The annual number of mild-to-moderate/severe exacerbations was 1.62 (1.9)/0.59 (1.3). Half of the patients (50%) presented with airflow obstruction (17% severe). The most frequent radiological localization was lower lobes. The average FACED/E-FACED/BSI values were 2.06 (1.7)/2.67 (2.2)/7.8 (4.5), respectively. Overall, 66.7% of patients were taking inhaled corticosteroids, 19.2% macrolides, and 19.5% inhaled antibiotics. Women presented a less severe profile than men in clinical and functional terms, and a similar infectious, radiological and therapeutic profile. CONCLUSIONS RIBRON represents an excellent map of the characteristics of bronchiectasis in our country. Two thirds of patients are women who presented lower disease severity as a specific characteristic.
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Affiliation(s)
| | - Carmen Villa
- Servicio de Neumología, Clínica Fuensanta, Madrid, España
| | | | - Rosa Girón
- Servicio de Neumología, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, España
| | - Luis Maíz
- Servicio de Neumología, Hospital Ramón y Cajal, Madrid, España
| | - Marta García-Clemente
- Servicio de Neumología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Oriol Sibila
- Servicio de Neumología, Hospital Clínico, Barcelona, España
| | - Rafael Golpe
- Servicio de Neumología, Hospital Lucus Augusti, Lugo, España
| | - Juan Rodríguez
- Servicio de Neumología, Hospital San Agustín, Avilés, Asturias, España
| | - Esther Barreiro
- Servicio de Neumología, Hospital del Mar-IMIM, UPF, CIBERES, Barcelona, España
| | | | - Rosario Menéndez
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | - David de la Rosa
- Servicio de Neumología, Hospital Santa Creu i Sant Pau, Barcelona, España
| | - Casilda Olveira
- Servicio de Neumología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Universidad de Málaga, Málaga, España
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