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Georges M, Perez T, Rabec C, Jacquin L, Finet-Monnier A, Ramos C, Patout M, Attali V, Amador M, Gonzalez-Bermejo J, Salachas F, Morelot-Panzini C. [Proposals from a French expert panel for respiratory care in ALS patients]. Rev Mal Respir 2024:S0761-8425(24)00232-8. [PMID: 39019674 DOI: 10.1016/j.rmr.2024.06.006] [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: 06/27/2021] [Accepted: 02/25/2022] [Indexed: 07/19/2024]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by progressive diaphragm weakness and deteriorating lung function. Bulbar involvement and cough weakness contribute to respiratory morbidity and mortality. ALS-related respiratory failure significantly affects quality of life and is the leading cause of death. Non-invasive ventilation (NIV), which is the main recognized treatment for alleviating the symptoms of respiratory failure, prolongs survival and improves quality of life. However, the optimal timing for the initiation of NIV is still a matter of debate. NIV is a complex intervention. Multiple factors influence the efficacy of NIV and patient adherence. The aim of this work was to develop practical evidence-based advices to standardize the respiratory care of ALS patients in French tertiary care centres. METHODS For each proposal, a French expert panel systematically searched an indexed bibliography and prepared a written literature review that was then shared and discussed. A combined draft was prepared by the chairman for further discussion. All of the proposals were unanimously approved by the expert panel. RESULTS The French expert panel updated the criteria for initiating NIV in ALS patients. The most recent criteria were established in 2005. Practical advice for NIV initiation were included and the value of each tool available for NIV monitoring was reviewed. A strategy to optimize NIV parameters was suggested. Revisions were also suggested for the use of mechanically assisted cough devices in ALS patients. CONCLUSION Our French expert panel proposes an evidence-based review to update the respiratory care recommendations for ALS patients in daily practice.
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Affiliation(s)
- M Georges
- Service des maladies respiratoires et des soins intensifs, centre de référence pour les maladies pulmonaires rares de l'adulte, hôpital universitaire de Dijon-Bourgogne, Dijon, France; Université de Bourgogne-Franche-Comté, Dijon, France; Centre des sciences du goût et de l'alimentation, UMR 6265, CNRS 1234, INRA, université de Bourgogne-Franche-Comté, Dijon, France.
| | - T Perez
- Service des maladies respiratoires, hôpital universitaire de Lille, Lille, France; Centre d'infection et d'immunité de Lille, Inserm U1019-UMR9017, université de Lille-Nord de France, Lille, France
| | - C Rabec
- Service des maladies respiratoires et des soins intensifs, centre de référence pour les maladies pulmonaires rares de l'adulte, hôpital universitaire de Dijon-Bourgogne, Dijon, France; Université de Bourgogne-Franche-Comté, Dijon, France
| | - L Jacquin
- Société ResMed SAS, Saint-Priest, France
| | - A Finet-Monnier
- Service des maladies neuromusculaires et de la SLA, hôpital universitaire de la Timone, Marseille, France
| | - C Ramos
- CRMR SLA-MNM, hôpital Pasteur 2, hôpital universitaire de Nice, Nice, France
| | - M Patout
- Département R3S, service des pathologies du sommeil, groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Neurophysiologie respiratoire expérimentale et clinique, Inserm UMRS1158, Sorbonne université, Paris, France
| | - V Attali
- Département R3S, service des pathologies du sommeil, groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Neurophysiologie respiratoire expérimentale et clinique, Inserm UMRS1158, Sorbonne université, Paris, France
| | - M Amador
- Service de neurologie, centre SLA de Paris, groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - J Gonzalez-Bermejo
- Neurophysiologie respiratoire expérimentale et clinique, Inserm UMRS1158, Sorbonne université, Paris, France; Département R3S, service de pneumologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - F Salachas
- Service de neurologie, centre SLA de Paris, groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - C Morelot-Panzini
- Neurophysiologie respiratoire expérimentale et clinique, Inserm UMRS1158, Sorbonne université, Paris, France; Département R3S, service de pneumologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
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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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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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Murphy PB, Patout M, Arbane G, Mandal S, Kaltsakas G, Polkey MI, Elliott M, Muir JF, Douiri A, Parkin D, Janssens JP, Pépin JL, Cuvelier A, Flach C, Hart N. Cost-effectiveness of outpatient versus inpatient non-invasive ventilation setup in obesity hypoventilation syndrome: the OPIP trial. Thorax 2023; 78:24-31. [PMID: 36342884 DOI: 10.1136/thorax-2021-218497] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/21/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Current guidelines recommend that patients with obesity hypoventilation syndrome (OHS) are electively admitted for inpatient initiation of home non-invasive ventilation (NIV). We hypothesised that outpatient NIV setup would be more cost-effective. METHODS Patients with stable OHS referred to six participating European centres for home NIV setup were recruited to an open-labelled clinical trial. Patients were randomised via web-based system using stratification to inpatient setup, with standard fixed level NIV and titrated during an attended overnight respiratory study or outpatient setup using an autotitrating NIV device and a set protocol, including home oximetry. The primary outcome was cost-effectiveness at 3 months with daytime carbon dioxide (PaCO2) as a non-inferiority safety outcome; non-inferiority margin 0.5 kPa. Data were analysed on an intention-to-treat basis. Health-related quality of life (HRQL) was measured using EQ-5D-5L (5 level EQ-5D tool) and costs were converted using purchasing power parities to £(GBP). RESULTS Between May 2015 and March 2018, 82 patients were randomised. Age 59±14 years, body mass index 47±10 kg/m2 and PaCO2 6.8±0.6 kPa. Safety analysis demonstrated no difference in ∆PaCO2 (difference -0.27 kPa, 95% CI -0.70 to 0.17 kPa). Efficacy analysis showed similar total per-patient costs (inpatient £2962±£580, outpatient £3169±£525; difference £188.20, 95% CI -£61.61 to £438.01) and similar improvement in HRQL (EQ-5D-5L difference -0.006, 95% CI -0.05 to 0.04). There were no differences in secondary outcomes. DISCUSSION There was no difference in medium-term cost-effectiveness, with similar clinical effectiveness, between outpatient and inpatient NIV setup. The home NIV setup strategy can be led by local resource demand and patient and clinician preference. TRIAL REGISTRATION NUMBERS NCT02342899 and ISRCTN51420481.
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Affiliation(s)
- Patrick Brian Murphy
- Lane Fox Respiratory Service, Guy's and St Thomas' Hospitals NHS Trust, London, UK .,Centre for Human & Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Maxime Patout
- Service des Pathologies du Sommeil (Département R3S), Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Paris, France.,UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, Paris, France
| | - Gill Arbane
- Lane Fox Respiratory Service, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Swapna Mandal
- Thoracic Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Georgios Kaltsakas
- Lane Fox Respiratory Service, Guy's and St Thomas' Hospitals NHS Trust, London, UK.,Centre for Human & Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Michael I Polkey
- NIHR Respiratory BRU, Royal Brompton Hospital and National Heart and Lung Institute, London, UK
| | - Mark Elliott
- Respiratory Medicine, St James' University Hospital, Leeds, UK
| | - Jean-François Muir
- Institute for Research and Innovation in Biomedicine (IRIB), Normandie Univ, UNIRouen, Rouen, France.,ADIR Assistance, Fédération ANTADIR, Paris, France
| | - Abdel Douiri
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | | | - Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospital, Geneva, Switzerland
| | - Jean Louis Pépin
- HP2 laboratory, INSERM U1042, Universite Grenoble Alpes, Saint-Martin-d'Heres, France.,Pôle Locomoteur, Rééducation et Physiologie, CHU de Grenoble, Grenoble, France
| | | | - Clare Flach
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Nicholas Hart
- Lane Fox Respiratory Service, Guy's and St Thomas' Hospitals NHS Trust, London, UK.,Centre for Human & Applied Physiological Sciences (CHAPS), King's College London, London, UK
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Home-Based Adaptation to Night-Time Non-Invasive Ventilation in Patients with Amyotrophic Lateral Sclerosis: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11113178. [PMID: 35683562 PMCID: PMC9181816 DOI: 10.3390/jcm11113178] [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] [Received: 04/26/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Initiation to Non-Invasive Ventilation (NIV) in amyotrophic lateral sclerosis (ALS) can be implemented in an inpatient or outpatient setting. Aims: We aimed to evaluate the efficacy of adaptation (the number of needed sessions) to home-based NIV compared to an outpatient one in ALS in terms of arterial carbon dioxide (PaCO2) improvement. NIV acceptance (mean use of ≥5 h NIV per night for three consecutive nights during the adaptation trial), adherence (night-time NIV usage for ≥150 h/month), quality of life (QoL), and caregiver burden were secondary outcomes. Methods: A total of 66 ALS patients with indications for NIV were involved in this randomized controlled trial (RCT): 34 underwent NIV initiation at home (home adaptation, HA) and 32 at multiple outpatient visits (outpatient adaptation, OA). Respiratory function tests were performed at baseline (the time of starting the NIV, T0) together with blood gas analysis, which was repeated at the end of adaptation (T1) and 2 (T2) and 6 (T3) months after T1. NIV adherence was measured at T2 and T3. Overnight cardiorespiratory polygraphy, Short Form Health Survey (SF-36), Caregiver Burden Inventory (CBI), Caregiver Burden Scale (CBS), and Zarit Burden Interview (ZBI) were performed at T0, T2, and T3. Results: Fifty-eight participants completed the study. No differences were found between groups in PaCO2 at T1 (p = 0.46), T2 (p = 0.50), and T3 (p = 0.34) in acceptance (p = 0.55) and adherence to NIV at T2 and T3 (p = 0.60 and p = 0.75, respectively). At T2, the patients’ QoL, assessed with SF-36, was significantly better in HA than in OA (p = 0.01), but this improvement was not maintained until T3 (p = 0.17). Conclusions: In ALS, adaptation to NIV in the patient’s home is as effective as that performed in an outpatient setting regarding PaCO2, acceptance, and adherence, which emphasizes the need for further studies to understand the role of the environment concerning NIV adherence.
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Georges M, Perez T, Rabec C, Jacquin L, Finet-Monnier A, Ramos C, Patout M, Attali V, Amador M, Gonzalez-Bermejo J, Salachas F, Morelot-Panzini C. Proposals from a French expert panel for respiratory care in ALS patients. Respir Med Res 2022; 81:100901. [PMID: 35378353 DOI: 10.1016/j.resmer.2022.100901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by progressive diaphragm weakness and deteriorating lung function. Bulbar involvement and cough weakness contribute to respiratory morbidity and mortality. ALS-related respiratory failure significantly affects quality of life and is the leading cause of death. Non-invasive ventilation (NIV), which is the main recognized treatment for alleviating the symptoms of respiratory failure, prolongs survival and improves quality of life. However, the optimal timing for the initiation of NIV is still a matter of debate. NIV is a complex intervention. Multiple factors influence the efficacy of NIV and patient adherence. The aim of this work was to develop practical evidence-based advices to standardize the respiratory care of ALS patients in French tertiary care centres. METHODS For each proposal, a French expert panel systematically searched an indexed bibliography and prepared a written literature review that was then shared and discussed. A combined draft was prepared by the chairman for further discussion. All of the proposals were unanimously approved by the expert panel. RESULTS The French expert panel updated the criteria for initiating NIV in ALS patients. The most recent criteria were established in 2005. Practical advice for NIV initiation were included and the value of each tool available for NIV monitoring was reviewed. A strategy to optimize NIV parameters was suggested. Revisions were also suggested for the use of mechanically assisted cough devices in ALS patients. CONCLUSION Our French expert panel proposes an evidence-based review to update the respiratory care recommendations for ALS patients in daily practice.
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Affiliation(s)
- M 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.
| | - T Perez
- Department of Respiratory Diseases, University Hospital of Lille, Lille, France; Centre for Infection and Immunity of Lille, INSERM U1019-UMR9017, University of Lille Nord de France, Lille, France
| | - C 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
| | - L Jacquin
- Clinical Training Manager for ResMed SAS company, Saint-Priest, France
| | - A Finet-Monnier
- Department of Neuromuscular Disorders and ALS, University Hospital of Timone, Marseille, France
| | - C Ramos
- CRMR SLA-MNM, Hôpital Pasteur 2, University Hospital of Nice, Nice, France
| | - M Patout
- Service des Pathologies du Sommeil (Département R3S), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Sorbonne Université, Paris, France
| | - V Attali
- Service des Pathologies du Sommeil (Département R3S), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Sorbonne Université, Paris, France
| | - M Amador
- Neurology Department, Paris ALS center, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - J Gonzalez-Bermejo
- Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Sorbonne Université, Paris, France; Service de Pneumologie (Département R3S), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - F Salachas
- Neurology Department, Paris ALS center, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - C Morelot-Panzini
- Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Sorbonne Université, Paris, France; Service de Pneumologie (Département R3S), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
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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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8
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Cost-Utility Analysis of Home Mechanical Ventilation in Patients with Amyotrophic Lateral Sclerosis. Healthcare (Basel) 2021; 9:healthcare9020142. [PMID: 33535635 PMCID: PMC7912812 DOI: 10.3390/healthcare9020142] [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: 12/06/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 11/16/2022] Open
Abstract
Amyotrophic lateral sclerosis is a disease with rapid progression. The use of mechanical ventilation helps to manage symptoms and delays death. Use in a home environment could reduce costs and increase quality of life. The aim of this study is a cost–utility analysis of home mechanical ventilation in adult patients with amyotrophic lateral sclerosis from the perspective of healthcare payers in the Czech Republic. The study evaluates home mechanical ventilation (HMV) and mechanical ventilation (MV) in a healthcare facility. A Markov model was compiled for evaluation in a timeframe of 10 years. Model parameters were obtained from the literature and opinions of experts from companies dealing with home care and home mechanical ventilation. The cost–utility analysis was carried out at the end of the study and results are presented in incremental cost–utility ratio (ICUR) using quality-adjusted life-years. Uncertainty was assessed by one-way sensitivity analysis and scenario analysis. The cumulative costs of HMV are CZK 1,877,076 and the cumulative costs of the MV are CZK 7,386,629. The cumulative utilities of HMV are 12.57 quality-adjusted life year (QALY) and the cumulative utilities of MV are 11.32 QALY. The ICUR value is CZK-4,403,259. The results of this study suggest that HMV is cost effective.
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9
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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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Egea-Santaolalla CJ, Chiner Vives E, Díaz Lobato S, Mangado NG, Lujan Tomé M, Mediano San Andrés O. Ventilación mecánica a domicilio. OPEN RESPIRATORY ARCHIVES 2020. [DOI: 10.1016/j.opresp.2020.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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11
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Morelot-Panzini C, Bruneteau G, Gonzalez-Bermejo J. NIV in amyotrophic lateral sclerosis: The 'when' and 'how' of the matter. Respirology 2019; 24:521-530. [PMID: 30912216 DOI: 10.1111/resp.13525] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 02/09/2019] [Accepted: 02/13/2019] [Indexed: 12/11/2022]
Abstract
Non-invasive ventilation (NIV) has become an essential part of the treatment of amyotrophic lateral sclerosis (ALS) since 2006. NIV very significantly improves survival, quality of life and cognitive performances. The initial NIV settings are simple, but progression of the disease, ventilator dependence and upper airway involvement sometimes make long-term adjustment of NIV more difficult, with a major impact on survival. Unique data concerning the long-term adjustment of NIV in ALS show that correction of leaks, management of obstructive apnoea and adaptation to the patient's degree of ventilator dependence improve the prognosis. Non-ventilatory factors also impact the efficacy of NIV and various solutions have been described and must be applied, including cough assist techniques, control of excess salivation and renutrition. NIV in ALS has been considerably improved as a result of application of all of these measures, avoiding the need for tracheostomy in the very great majority of cases. More advanced use of NIV also requires pulmonologists to master the associated end-of-life palliative care, as well as the modalities of discontinuing ventilation when it becomes unreasonable.
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Affiliation(s)
- Capucine Morelot-Panzini
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France.,Service de Pneumologie et Réanimation Médicale du Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Gaëlle Bruneteau
- Institut du Cerveau et de la Moelle épinière, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France.,Département de Neurologie, Centre Référent SLA, APHP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Jesus Gonzalez-Bermejo
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France.,Service de Pneumologie et Réanimation Médicale du Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
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12
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Suh ES, Murphy PB, Hart N. Home mechanical ventilation for chronic obstructive pulmonary disease: What next after the HOT-HMV trial? Respirology 2019; 24:732-739. [PMID: 30729638 DOI: 10.1111/resp.13484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/02/2019] [Indexed: 12/26/2022]
Abstract
The benefits of acute non-invasive ventilation to treat acidotic exacerbations of chronic obstructive pulmonary disease (COPD) are well-established. Until recently, the evidence for home mechanical ventilation (HMV) to treat patients with stable COPD had been lacking. This has subsequently been addressed by the application of higher levels of pressure support combined with targeted management of chronic respiratory failure, which demonstrated a reduction in all-cause mortality. Similarly, the previous trial of home oxygen therapy (HOT) and HMV delivered following an acute exacerbation failed to demonstrate an improvement in outcome. With the focus on patients with persistent hypercapnic respiratory failure in the recovery phase following a life-threatening exacerbation combined with targeted reduction in carbon dioxide, HOT and HMV (HOT-HMV) was shown to be clinically effective in reducing the time to readmission or death and cost effective in both the United Kingdom and United States healthcare systems. Future work will need to focus on promoting adherence to home ventilation and novel auto-titrating ventilator modes to facilitate and optimize the set-up of overnight ventilatory support in different target population such as COPD patients with obstructive sleep apnoea and COPD patients with episodic nocturnal hypoventilation.
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Affiliation(s)
- Eui-Sik Suh
- Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Patrick B Murphy
- Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Nicholas Hart
- Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, UK
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13
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Durão V, Grafino M, Pamplona P. Chronic respiratory failure in patients with chronic obstructive pulmonary disease under home noninvasive ventilation: Real-life study. Pulmonology 2018; 24:280-288. [PMID: 29628437 DOI: 10.1016/j.pulmoe.2018.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 02/05/2018] [Accepted: 02/13/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Home noninvasive ventilation (NIV) has been increasingly used in stable chronic obstructive pulmonary disease (COPD) with chronic hypercapnic respiratory failure (CHRF). However its effectiveness remains debatable. AIM To describe a follow-up of COPD patients under home NIV. METHODS Retrospective descriptive study based on a prospective 3-year database that included COPD patients under home NIV between August 2011 and July 2014. RESULTS Within the 334 patients initially screened, 109 (32.6%) had COPD with a mean±SD post-bronchodilator FEV1 of 38.6±14.9% predicted; age of 65.6±9.6 years. The mean±SD duration of ventilation was 63.4±51.1 months. Heterogeneous comorbidities that can contribute to CHRF were not excluded: obstructive sleep apnea and obesity were the most prevalent. Sixty-two (56.9%) patients started NIV during admission with acute respiratory failure. During follow-up there was a significant increase in mean inspiratory positive airway pressure (IPAP) and respiratory rate (19.5±4.4 vs. 23.6±5.3cmH2O and 10.7±5.2 vs. 15.2±1.4 breaths/min, respectively, p<0.0001), with a significant improvement in hypercapnia (PaCO2: 52.9±7.7 vs. 49.5±7.5mmHg, p<0.0001), with 93.3% of patients compliant to NIV. Admissions and days spent in hospital for respiratory illness significantly decreased after institution of NIV (respectively, 1.2±1.1 vs. 0.7±1.8 and 15.0±16.8 vs. 8.8±19.4, p<0.001). At final evaluation, patients with severe hypercapnia (n=47; PaCO2 ≥50mmHg) performing NIV at higher pressures (n=30; IPAP ≥25cmH2O) were more compliant (10.1±3.3 vs. 6.1±3.6h/day). Three-year mortality was 24.8% (27 of 109 patients). CONCLUSIONS This is a real-life retrospective study in COPD patients with CHRF which results suggest benefit from home NIV. For most, NIV was effective and tolerable even at high pressures.
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Affiliation(s)
- V Durão
- Serviço Pneumologia, Hospital Pulido Valente, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - M Grafino
- Serviço Pneumologia, Hospital Pulido Valente, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.
| | - P Pamplona
- Serviço Pneumologia, Hospital Pulido Valente, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
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14
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A Chemical-Biological-Radio-Nuclear (CBRN) Filter can be Added to the Air-Outflow Port of a Ventilator to Protect a Home Ventilated Patient From Inhalation of Toxic Industrial Compounds. Disaster Med Public Health Prep 2018; 12:739-743. [PMID: 29463330 PMCID: PMC7112992 DOI: 10.1017/dmp.2018.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives Chemical-biological-radio-nuclear (CBRN) gas masks are the standard means for protecting the general population from inhalation of toxic industrial compounds (TICs), for example after industrial accidents or terrorist attacks. However, such gas masks would not protect patients on home mechanical ventilation, as ventilator airflow would bypass the CBRN filter. We therefore evaluated in vivo the safety of adding a standard-issue CBRN filter to the air-outflow port of a home ventilator, as a method for providing TIC protection to such patients. Methods Eight adult patients were included in the study. All had been on stable, chronic ventilation via a tracheostomy for at least 3 months before the study. Each patient was ventilated for a period of 1 hour with a standard-issue CBRN filter canister attached to the air-outflow port of their ventilator. Physiological and airflow measurements were made before, during, and after using the filter, and the patients reported their subjective sensation of ventilation continuously during the trial. Results For all patients, and throughout the entire study, no deterioration in any of the measured physiological parameters and no changes in measured airflow parameters were detected. All patients felt no subjective difference in the sensation of ventilation with the CBRN filter canister in situ, as compared with ventilation without it. This was true even for those patients who were breathing spontaneously and thus activating the ventilator’s trigger/sensitivity function. No technical malfunctions of the ventilators occurred after addition of the CBRN filter canister to the air-outflow ports of the ventilators. Conclusions A CBRN filter canister can be added to the air-outflow port of chronically ventilated patients, without causing an objective or subjective deterioration in the quality of the patients’ mechanical ventilation. (Disaster Med Public Health Preparedness. 2018;12:739-743)
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15
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Nonoyama ML, McKim DA, Road J, Guerriere D, Coyte PC, Wasilewski M, Avendano M, Katz SL, Amin R, Goldstein R, Zagorski B, Rose L. Healthcare utilisation and costs of home mechanical ventilation. Thorax 2018; 73:thoraxjnl-2017-211138. [PMID: 29374088 DOI: 10.1136/thoraxjnl-2017-211138] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/23/2017] [Accepted: 12/11/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Individuals using home mechanical ventilation (HMV) frequently choose to live at home for quality of life, despite financial burden. Previous studies of healthcare utilisation and costs do not consider public and private expenditures, including caregiver time. OBJECTIVES To determine public and private healthcare utilisation and costs for HMV users living at home in two Canadian provinces, and examine factors associated with higher costs. METHODS Longitudinal, prospective observational cost analysis study (April 2012 to August 2015) collecting data on public and private (out-of-pocket, third-party insurance, caregiving) costs every 2 weeks for 6 months using the Ambulatory and Home Care Record. Functional Independence Measure (FIM) was used at baseline and study completion. Regression models examined variables associated with total monthly costs selected a priori using Andersen and Newman's framework for healthcare utilisation, relevant literature, and clinical expertise. Data are reported in 2015 Canadian dollars ($C1=US$0.78=₤0.51=€0.71). RESULTS We enrolled 134 HMV users; 95 with family caregivers. Overall median (IQR) monthly healthcare cost was $5275 ($2291-$10 181) with $2410 (58%) publicly funded; $1609 (39%) family caregiving; and $141 (3%) out-of-pocket (<1% third-party insurance). Median healthcare costs were $8733 ($5868-$15 274) for those invasively ventilated and $3925 ($1212-$7390) for non-invasive ventilation. Variables associated with highest monthly costs were amyotrophic lateral sclerosis (1.88, 95% CI 1.09 to 3.26, P<0.03) and lower FIM quintiles (higher dependency) (up to 6.98, 95% CI 3.88 to 12.55, P<0.0001) adjusting for age, sex, tracheostomy and ventilation duration. CONCLUSIONS For HMV users, most healthcare costs were publicly supported or associated with family caregiving. Highest costs were incurred by the most dependent users. Understanding healthcare costs for HMV users will inform policy decisions to optimise resource allocation, helping individuals live at home while minimising caregiver burden.
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Affiliation(s)
- Mika L Nonoyama
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
- Department of Respiratory Therapy, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Douglas A McKim
- Division of Respiratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Denise Guerriere
- Division of Respirology, Department of Medicine, Institute for Heart and Lung Health, University of British Columbia, Vancouver, British Columbia, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Canadian Centre for Health Economics, Toronto, Ontario, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Marina Wasilewski
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Monica Avendano
- Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sherri L Katz
- Division of Respirology, Department of Pediatrics, CHEO, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Research Unit, CHEO Research Institute, Ottawa, Ontario, Canada
| | - Reshma Amin
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Roger Goldstein
- Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brandon Zagorski
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Louise Rose
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Schwarz S, Callegari J, Hamm C, Windisch W, Magnet F. Is Outpatient Control of Long-Term Non-Invasive Ventilation Feasible in Chronic Obstructive Pulmonary Disease Patients? Respiration 2017; 95:154-160. [DOI: 10.1159/000484569] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 10/24/2017] [Indexed: 11/19/2022] Open
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17
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Freitas AC, Lavrador V, Coelho I, Sousa R, Senra V, Morais L. Integrated domiciliary ventilation outpatient clinic - Description and experience of an integrated and multidisciplinary model. REVISTA PORTUGUESA DE PNEUMOLOGIA 2016; 22:180-181. [PMID: 26702756 DOI: 10.1016/j.rppnen.2015.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/24/2015] [Accepted: 10/29/2015] [Indexed: 06/05/2023] Open
Affiliation(s)
- A C Freitas
- Pediatric Pulmonology, Pediatric Department, Centro Hospitalar do Porto, Portugal.
| | - V Lavrador
- Pediatric Pulmonology, Pediatric Department, Centro Hospitalar do Porto, Portugal.
| | - I Coelho
- Pediatric Care Point REMEO, Linde Healthcare, Portugal.
| | - R Sousa
- Pediatric Pulmonology, Pediatric Department, Centro Hospitalar do Porto, Portugal.
| | - V Senra
- Pediatric Pulmonology, Pediatric Department, Centro Hospitalar do Porto, Portugal.
| | - L Morais
- Pediatric Pulmonology, Pediatric Department, Centro Hospitalar do Porto, Portugal.
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Lujan M, Esquinas AM. Ambulatory adaptation of non-invasive ventilation in motor neuron disease: Where limits of effectiveness end. Amyotroph Lateral Scler Frontotemporal Degener 2014; 16:137-8. [DOI: 10.3109/21678421.2014.951947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Sheers N, Howard ME, Berlowitz DJ. Ambulatory adaptation of non-invasive ventilation in Motor Neuron Disease: where limits of effectiveness end. Amyotroph Lateral Scler Frontotemporal Degener 2014; 16:139-40. [DOI: 10.3109/21678421.2014.954249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Pallero M, Puy C, Güell R, Pontes C, Martí S, Torres F, Antón A, Muñoz X. Ambulatory adaptation to noninvasive ventilation in restrictive pulmonary disease: A randomized trial with cost assessment. Respir Med 2014; 108:1014-22. [DOI: 10.1016/j.rmed.2014.04.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 03/28/2014] [Accepted: 04/20/2014] [Indexed: 11/30/2022]
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21
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Chiner E, Barreiro E, de Lucas P. Año SEPAR 2014 del paciente crónico y las terapias respiratorias domiciliarias. Puntos para la reflexión. Arch Bronconeumol 2014; 50:159-60. [DOI: 10.1016/j.arbres.2014.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 02/09/2014] [Accepted: 02/10/2014] [Indexed: 11/17/2022]
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Sheers N, Berlowitz DJ, Rautela L, Batchelder I, Hopkinson K, Howard ME. Improved survival with an ambulatory model of non-invasive ventilation implementation in motor neuron disease. Amyotroph Lateral Scler Frontotemporal Degener 2014; 15:180-4. [PMID: 24555916 DOI: 10.3109/21678421.2014.881376] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Non-invasive ventilation (NIV) increases survival and quality of life in motor neuron disease (MND). NIV implementation historically occurred during a multi-day inpatient admission at this institution; however, increased demand led to prolonged waiting times. The aim of this study was to evaluate the introduction of an ambulatory model of NIV implementation. A prospective cohort study was performed. Inclusion criteria were referral for NIV implementation six months pre- or post-commencement of the Day Admission model. This model involved a 4-h stay to commence ventilation with follow-up in-laboratory polysomnography titration and outpatient attendance. Outcome measures included waiting time, hospital length of stay, adverse events and polysomnography data. Results indicated that after changing to the Day Admission model the median waiting time fell from 30 to 13.5 days (p < 0.04) and adverse events declined (4/17 pre- (three deaths, one acute admission) vs. 0/12 post-). Survival was also prolonged (median (IQR) 278 (51-512) days pre- vs 580 (306-1355) days post-introduction of the Day Admission model; hazard ratio 0.41, p = 0.04). Daytime PaCO2 was no different. In conclusion, reduced waiting time to commence ventilation and improved survival were observed following introduction of an ambulatory model of NIV implementation in people with MND, with no change in the effectiveness of ventilation.
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Affiliation(s)
- Nicole Sheers
- Victorian Respiratory Support Service (VRSS), Austin Health , Heidelberg, Victoria , Australia
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23
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Twenty-four hour noninvasive ventilation in Duchenne muscular dystrophy: a safe alternative to tracheostomy. Can Respir J 2013; 20:e5-9. [PMID: 23457679 DOI: 10.1155/2013/406163] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Almost all patients with Duchenne muscular dystrophy (DMD) eventually develop respiratory failure. Once 24 h ventilation is required, either due to incomplete effectiveness of nocturnal noninvasive ventilation (NIV) or bulbar weakness, it is common practice to recommend invasive tracheostomy ventilation; however, noninvasive daytime mouthpiece ventilation (MPV) as an addition to nocturnal mask ventilation is also an alternative. METHODS The authors' experience with 12 DMD patients who used 24 h NIV with mask NIV at night and MPV during daytime hours is reported. RESULTS The mean (± SD) age and vital capacity (VC) at initiation of nocturnal (only) NIV subjects were 17.8±3.5 years and 0.90±0.40 L (21% predicted), respectively; and, at the time of MPV, 19.8±3.4 years and 0.57 L (13.2% predicted), respectively. In clinical practice, carbon dioxide (CO2) levels were measured using different methods: arterial blood gas analysis, transcutaneous partial pressure of CO2 and, predominantly, by end-tidal CO2. While the results suggested improved CO2 levels, these were not frequently confirmed by arterial blood gas measurement. The mean survival on 24 h NIV has been 5.7 years (range 0.17 to 12 years). Of the 12 patients, two deaths occurred after 3.75 and four years, respectively, on MPV; the remaining patients continue on 24 h NIV (range two months to 12 years; mean 5.3 years; median 3.5 years). CONCLUSIONS Twenty-four hour NIV should be considered a safe alternative for patients with DMD because its use may obviate the need for tracheostomy in patients with chronic respiratory failure requiring more than nocturnal ventilation alone.
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McKim DA, King J, Walker K, Leblanc C, Timpson D, Wilson KG, Marks M, Curran D, Woolnough A. Formal ventilation patient education for ALS predicts real-life choices. ACTA ACUST UNITED AC 2012; 13:59-65. [PMID: 22214354 DOI: 10.3109/17482968.2011.626053] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our objective was to evaluate a single-session, hands-on education programme on mechanical ventilation for ALS patients and caregivers in terms of knowledge, change in affect and to determine whether ventilator decisions made after the education sessions predict those made later in life. Questionnaires were administered to 26 patients and 26 caregivers on four separate occasions. The questionnaires assessed knowledge of ventilatory support, feedback on the nature of the education programme, as well as self-reported emotional well-being. All patients were followed until their death or until initiation of invasive ventilation. Both groups demonstrated significant improvements in knowledge as a result of the education session which was retained after one month. There was no change in patient or caregiver reports' self-reported emotional well-being. The choices of ventilatory support expressed at one month (T4) accurately predicted the real-life clinical choices made by 76% of patients. Any difference resulted from choosing palliative care. Hands-on patient and caregiver education results in improved knowledge, assists in decision-making with respect to ventilatory support, and is not associated with a worsening of affect. It also provides for an accurate prediction of real-life choices and avoids undesired life support interventions and critical care admissions.
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Affiliation(s)
- Douglas A McKim
- Respiratory Rehabilitation Services and The Ottawa Hospital Sleep Centre, Department of Medicine, University of Ottawa, 1201-505 Smyth Road, Ottawa, Ontario, Canada.
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Abstract
Amyotrophic Lateral Sclerosis (ALS) is a progressive and fatal neurodegenerative disease in which much burden is geared towards end-of-life care. Particularly in the earlier stages of ALS, many people have found both physiological and psychological boosts from various types of physical exercise for disused muscles. Proper exercise is important for preventing atrophy of muscles from disuse-a key for remaining mobile for as long as possible-and as long as it is possible to exercise comfortably and safely, for preserving cardiovascular fitness. However, the typical neuromuscular patient features a great physical inactivity and disuse weakness, and for that reason many controversial authors have contested exercise in these patients during years, especially in ALS which is rapidly progressive. There is an urgent need for dissecting in detail the real risks or benefits of exercise in controlled clinical trials to demystify this ancient paradigm. Yet, recent research studies document significant benefits in terms of survival and quality of life in ALS, poor cooperation, small sample size, uncontrolled and short-duration trials, remain the main handicaps. Sedentary barriers such as early fatigue and inherent muscle misuse should be overcome, for instance with body-weight supporting systems or non-invasive ventilation, and exercise should be faced as a potential non-monotonous way for contributing to better health-related quality of life.
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Scarpazza P, Incorvaia C, Amboni P, di Franco G, Raschi S, Usai P, Bernareggi M, Bonacina C, Melacini C, Cattaneo R, Bencini S, Pravettoni C, Riario-Sforza GG, Passalacqua G, Casali W. Long-term survival in elderly patients with a do-not-intubate order treated with noninvasive mechanical ventilation. Int J Chron Obstruct Pulmon Dis 2011; 6:253-7. [PMID: 21814461 PMCID: PMC3144845 DOI: 10.2147/copd.s18501] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Indexed: 11/23/2022] Open
Abstract
Background: Noninvasive mechanical ventilation (NIMV) is an effective tool in treating patients with acute respiratory failure (ARF), since it reduces both the need for endotracheal intubation and the mortality in comparison with nonventilated patients. A particular issue is represented by the outcome of NIMV in patients referred to the emergency department for ARF and with a do-not-intubate (DNI) status because of advanced age or excessively critical conditions. This study evaluated long-term survival in a group of elderly patients with acute hypercapnic ARF who had a DNI order and who were successfully treated by NIMV. Methods: The population consisted of 54 patients with a favorable outcome after NIMV for ARF. They were followed up for 3 years by regular control visits, with at least one visit every 4 months, or as needed according to the patient’s condition. Of these, 31 continued NIMV at home and 23 were on long-term oxygen therapy (LTOT) alone. Results: A total of 16 of the 52 patients had not survived at the 1-year follow-up, and another eight patients died during the 3-year observation, with an overall mortality rate of 30.8% after 1 year and 46.2% after 3 years. Comparing patients who continued NIMV at home with those who were on LTOT alone, 9 of the 29 patients on home NIMV died (6 after 1 year and 3 after 3 years) and 15 of the 23 patients on LTOT alone died (10 after 1 year and 5 after 3 years). Conclusion: These results show that elderly patients with ARF successfully treated by NIMV following a DNI order have a satisfactory long-term survival.
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Affiliation(s)
- Paolo Scarpazza
- Divisione di Broncopneumotisiologia, Ospedale Civile, Vimercate, Italy
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Hospitales de día de enfermedades respiratorias: ¿qué hemos aprendido? Med Clin (Barc) 2011; 136:454-5. [DOI: 10.1016/j.medcli.2009.07.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 07/03/2009] [Accepted: 07/14/2009] [Indexed: 10/20/2022]
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Lindahl B. Patients’ suggestions about how to make life at home easier when dependent on ventilator treatment - a secondary analysis. Scand J Caring Sci 2010; 24:684-92. [DOI: 10.1111/j.1471-6712.2009.00763.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mise en route d’une ventilation non invasive : pratiques actuelles et évolutions attendues. Enquêtes du groupe de travail CasaVNI. Rev Mal Respir 2010; 27:1022-9. [DOI: 10.1016/j.rmr.2010.09.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 09/03/2010] [Indexed: 11/21/2022]
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Rabec C, Gonzalez-Bermejo J, Arnold V, Rouault S, Gillet V, Perrin C, Alluin F, Muir JF, Veale D. Mise en route d’une ventilation non invasive au domicile : propositions du groupe de travail Casavni. Rev Mal Respir 2010; 27:874-89. [DOI: 10.1016/j.rmr.2010.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 03/23/2010] [Indexed: 11/15/2022]
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Domingo C, Blanch L, Murias G, Luján M. State-of-the-art sensor technology in Spain: invasive and non-invasive techniques for monitoring respiratory variables. SENSORS 2010; 10:4655-74. [PMID: 22399898 PMCID: PMC3292138 DOI: 10.3390/s100504655] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 03/29/2010] [Accepted: 04/15/2010] [Indexed: 11/16/2022]
Abstract
The interest in measuring physiological parameters (especially arterial blood gases) has grown progressively in parallel to the development of new technologies. Physiological parameters were first measured invasively and at discrete time points; however, it was clearly desirable to measure them continuously and non-invasively. The development of intensive care units promoted the use of ventilators via oral intubation ventilators via oral intubation and mechanical respiratory variables were progressively studied. Later, the knowledge gained in the hospital was applied to out-of-hospital management. In the present paper we review the invasive and non-invasive techniques for monitoring respiratory variables.
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Affiliation(s)
- Christian Domingo
- Pneumology Service, Hospital de Sabadell, Corporació Parc Taulí, 08208 Sabadell, Spain
- Department of Medicine, Autonomous University of Barcelona (UAB), 083208 Bellaterra, Barcelona, Spain
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: + 34- 93-723-10-10, ext. 29-142; Fax: + 34-93-716-06-46
| | - Lluis Blanch
- Critical Care Center; Hospital de Sabadell, Corporació Parc Taulí, 08208 Sabadell, Spain; E-Mail:
- Institut Universitari Fundació Parc Taulí, Corporació Parc Taulí Autonomous University of Barcelona (UAB). 08208 Sabadell, Spain
- CIBER Enfermedades Respiratorias CIBERes, Spain
| | - Gaston Murias
- Intensive Care Unit, Clínica Bazterrica and Clínica Santa Isabel. Buenos Aires, Argentina; E-Mail:
| | - Manel Luján
- Pneumology Service, Hospital de Sabadell, Corporació Parc Taulí, 08208 Sabadell, Spain
- Department of Medicine, Autonomous University of Barcelona (UAB), 083208 Bellaterra, Barcelona, Spain
- CIBER Enfermedades Respiratorias CIBERes, Spain
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Optimal clinical time for reliable measurement of transcutaneous CO2 with ear probes: counterbalancing overshoot and the vasodilatation effect. SENSORS 2010; 10:491-500. [PMID: 22315552 PMCID: PMC3270853 DOI: 10.3390/s100100491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 12/20/2009] [Accepted: 12/21/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES: To determine the optimal clinical reading time for the transcutaneous measurement of oxygen saturation (SpO2) and transcutaneous CO2 (TcPCO2) in awake spontaneously breathing individuals, considering the overshoot phenomenon (transient overestimation of arterial PaCO2). EXPERIMENTAL SECTION: Observational study of 91 (75 men) individuals undergoing forced spirometry, measurement of SpO2 and TcPCO2 with the SenTec monitor every two minutes until minute 20 and arterial blood gas (ABG) analysis. Overshoot severity: (a) mild (0.1–1.9 mm Hg); (b) moderate (2–4.9 mm Hg); (c) severe: (>5 mm Hg). The mean difference was calculated for SpO2 and TcPCO2 and arterial values of PaCO2 and SpO2. The intraclass correlation coefficient (ICC) between monitor readings and blood values was calculated as a measure of agreement. RESULTS: The mean age was 63.1 ± 11.8 years. Spirometric values: FVC: 75.4 ± 6.2%; FEV1: 72.9 ± 23.9%; FEV1/FVC: 70 ± 15.5%. ABG: PaO2: 82.6 ± 13.2; PaCO2: 39.9.1 ± 4.8 mmHg; SaO2: 95.3 ± 4.4%. Overshoot analysis: overshoot was mild in 33 (36.3%) patients, moderate in 20 (22%) and severe in nine (10%); no overshoot was observed in 29 (31%) patients. The lowest mean differences between arterial blood gas and TcPCO2 was −0.57 mmHg at minute 10, although the highest ICC was obtained at minutes 12 and 14 (>0.8). The overshoot lost its influence after minute 12. For SpO2, measurements were reliable at minute 2. CONCLUSIONS: The optimal clinical reading measurement recommended for the ear lobe TcPCO2 measurement ranges between minute 12 and 14. The SpO2 measurement can be performed at minute 2.
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Evers G, Loey CV. Monitoring Patient/Ventilator Interactions: Manufacturer's Perspective. Open Respir Med J 2009; 3:17-26. [PMID: 19452035 PMCID: PMC2682925 DOI: 10.2174/1874306400903010017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Revised: 01/28/2009] [Accepted: 02/12/2009] [Indexed: 11/22/2022] Open
Abstract
The introduction of reduced and more powerful electronics has allowed the transition of medical equipment such as respiratory support devices from the hospital to the patient’s home environment. Even if this move could be beneficial for the patient, the clinician ends up in a delicate situation where little or no direct supervision is possible on the delivered treatment. Progress in technologies led to an improved handling of patient-device interaction: manufacturers are promoting new or improved ventilation modes or cycling techniques for better patient-ventilator coupling. Even though these ventilation modes have become more responsive to patient efforts, adversely they might lead to events such as false triggering, autotriggering, delayed triggering. In addition, manufacturers are developing tools to enhance the follow-up, remotely or offline, of the treatment by using embedded memory in the respiratory devices. This logging might be beneficial for the caregiver to review and document the treatment and tune the settings to the patient’s need and comfort. Also, remote telemedicine has been raised as a potential solution for many years without yet overall acceptance due to legal, technical and ethical problems. Benefits of new technologies in respiratory support devices give the technical foundation for the transition from hospital to home and reducing patient/ventilator asynchronies. Healthcare infrastructure has to follow this trend in terms of cost savings versus hospital stays.
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Affiliation(s)
- Gerard Evers
- Breas Medical AB, Företagsvägen 1, SE-435 33 Mölnlycke, Sweden
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Doménech-Clar R, Nauffal-Manssur D, Compte-Torrero L, Rosales-Almazán MD, Martínez-Pérez E, Soriano-Melchor E. Adaptation and follow-up to noninvasive home mechanical ventilation: Ambulatory versus hospital. Respir Med 2008; 102:1521-7. [DOI: 10.1016/j.rmed.2008.07.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 07/10/2008] [Accepted: 07/15/2008] [Indexed: 10/21/2022]
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