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Tregidgo L, Naran P, Gosal E, D'Cruz RF. Update in Noninvasive Home Mechanical Ventilation: A Narrative Review of Indications, Outcomes, and Monitoring. Can Respir J 2024; 2024:7013576. [PMID: 38989047 PMCID: PMC11236466 DOI: 10.1155/2024/7013576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/29/2024] [Accepted: 06/11/2024] [Indexed: 07/12/2024] Open
Abstract
Hypercapnic respiratory failure arises due to an imbalance in the load-capacity-drive relationship of the respiratory muscle pump, typically arising in patients with chronic obstructive pulmonary disease, obesity-related respiratory failure, and neuromuscular disease. Patients at risk of developing chronic respiratory failure and those with established disease should be referred to a specialist ventilation unit for evaluation and consideration of home noninvasive ventilation (NIV) initiation. Clinical trials demonstrate that, following careful patient selection, home NIV can improve a range of clinical, patient-reported, and physiological outcomes. This narrative review provides an overview of the pathophysiology of chronic respiratory failure, evidence-based applications of home NIV, and monitoring of patients established on home ventilation and describes technological advances in ventilation devices, interfaces, and monitoring to enhance comfort, promote long-term adherence, and optimise gas exchange.
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Affiliation(s)
- Laura Tregidgo
- Lane Fox Respiratory UnitGuys and St Thomas' NHS Foundation Trust, London, UK
| | - Prasheena Naran
- Department of Respiratory MedicineBarts Health NHS Foundation Trust, London, UK
| | - Eshrina Gosal
- Department of Respiratory MedicineUniversity College London Hospitals NHS Foundation Trust, London, UK
| | - Rebecca F. D'Cruz
- Lane Fox Respiratory UnitGuys and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological SciencesKing's College London, London, UK
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Shah NM, Steier J, Hart N, Kaltsakas G. Effects of non-invasive ventilation on sleep in chronic hypercapnic respiratory failure. Thorax 2024; 79:281-288. [PMID: 37979970 DOI: 10.1136/thorax-2023-220035] [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: 05/28/2023] [Accepted: 10/23/2023] [Indexed: 11/20/2023]
Abstract
Chronic respiratory disease can exacerbate the normal physiological changes in ventilation observed in healthy individuals during sleep, leading to sleep-disordered breathing, nocturnal hypoventilation, sleep disruption and chronic respiratory failure. Therefore, patients with obesity, slowly and rapidly progressive neuromuscular disease and chronic obstructive airways disease report poor sleep quality. Non-invasive ventilation (NIV) is a complex intervention used to treat sleep-disordered breathing and nocturnal hypoventilation with overnight physiological studies demonstrating improvement in sleep-disordered breathing and nocturnal hypoventilation, and clinical trials demonstrating improved outcomes for patients. However, the impact on subjective and objective sleep quality is dependent on the tools used to measure sleep quality and the patient population. As home NIV becomes more commonly used, there is a need to conduct studies focused on sleep quality, and the relationship between sleep quality and health-related quality of life, in all patient groups, in order to allow the clinician to provide clear patient-centred information.
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Affiliation(s)
- Neeraj M Shah
- Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Joerg Steier
- Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Nicholas Hart
- Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Georgios Kaltsakas
- Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
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D'Cruz RF, Kaltsakas G, Suh ES, Hart N. Quality of life in patients with chronic respiratory failure on home mechanical ventilation. Eur Respir Rev 2023; 32:32/168/220237. [PMID: 37137507 PMCID: PMC10155047 DOI: 10.1183/16000617.0237-2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/07/2023] [Indexed: 05/05/2023] Open
Abstract
Home mechanical ventilation (HMV) is a treatment for chronic respiratory failure that has shown clinical and cost effectiveness in patients with underlying COPD, obesity-related respiratory failure and neuromuscular disease (NMD). By treating chronic respiratory failure with adequate adherence to HMV, improvement in patient-reported outcomes including health-related quality of life (HRQoL) have been evaluated using general and disease-specific quantitative, semi-qualitative and qualitative methods. However, the treatment response in terms of trajectory of change in HRQoL is not uniform across the restrictive and obstructive disease groups. In this review, the effect of HMV on HRQoL across the domains of symptom perception, physical wellbeing, mental wellbeing, anxiety, depression, self-efficacy and sleep quality in stable and post-acute COPD, rapidly progressive NMD (such as amyotrophic lateral sclerosis), inherited NMD (including Duchenne muscular dystrophy) and obesity-related respiratory failure will be discussed.
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Affiliation(s)
- Rebecca F D'Cruz
- Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, London, UK
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Georgios Kaltsakas
- Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, London, UK
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Eui-Sik Suh
- Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, London, UK
- Centre for Life Sciences, King's College London, London, UK
| | - Nicholas Hart
- Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, London, UK
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK
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Cheng MC, Steier J. Pre-operative screening for sleep disordered breathing: obstructive sleep apnoea and beyond. Breathe (Sheff) 2022; 18:220072. [PMID: 36340822 PMCID: PMC9584551 DOI: 10.1183/20734735.0072-2022] [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: 05/03/2022] [Accepted: 07/18/2022] [Indexed: 11/06/2022] Open
Abstract
Sleep disordered breathing describes an important group of conditions that causes abnormal nocturnal gas exchange, with important implications in the peri-operative management plan. An understanding of the pathophysiology behind obstructive sleep apnoea and other disorders that may lead to hypoventilation can help to prevent complications. Patients with these disorders may be minimally symptomatic and it requires careful screening in the pre-operative assessment process for a diagnosis to be made. Decisions regarding initiation of therapy, such as positive airway pressure, and delay of the operation need to be carefully weighed up against the urgency of the surgical intervention. Planning of the peri-operative care, including the use of positive airway pressure therapy and appropriate post-operative monitoring, can help to avoid respiratory and cardiovascular morbidities and improve clinical outcomes. Educational aims To review different types of sleep disordered breathing and available screening methods in pre-operative assessment.To understand the pathophysiology behind sleep disordered breathing and how it can lead to complications in the peri-operative setting.To review the planning and treatment strategies that should be considered as part of peri-operative management.
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Affiliation(s)
- Michael C.F. Cheng
- Lane Fox Unit/Sleep Disorders Centre, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Centre for Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Joerg Steier
- Lane Fox Unit/Sleep Disorders Centre, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Isaac BTJ, Priya N, Nair AA, Thangakunam B, Balachandran A, George T, Thomas SM, George TK, Iyadurai R, Kumar SS, Zachariah A, Singh B, Rupali P, Pichamuthu K, Gupta R, Daniel J, Sasikumar JR, Chandy ST, Christopher DJ. Treatment of COVID-19 Acute Respiratory Distress Syndrome With a Tabletop Noninvasive Ventilation Device in a Respiratory Intermediate Care Unit. Mayo Clin Proc Innov Qual Outcomes 2022; 6:239-249. [PMID: 35463482 PMCID: PMC9015959 DOI: 10.1016/j.mayocpiqo.2022.04.001] [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: 01/08/2023] Open
Abstract
Objective To study the outcomes of noninvasive ventilation (NIV) administered through a tabletop device for coronavirus disease 2019 acute respiratory distress syndrome in the respiratory intermediate care unit (RIMCU) at a tertiary care hospital in India. Patients and Methods We retrospectively studied a cohort of hospitalized patients deteriorating despite low-flow oxygen support who received protocolized management with positive airway pressure using a tabletop NIV device in the RIMCU as a step-up rescue therapy from July 30, 2020 to November 14, 2020. Treatment was commenced on the continuous positive airway pressure mode up to a pressure of 10 cm of H2O, and if required, inspiratory pressures were added using the bilevel positive air pressure mode. Success was defined as weaning from NIV and stepping down to the ward, and failure was defined as escalation to the intensive care unit, the need for intubation, or death. Results In total, 246 patients were treated in the RIMCU during the study period. Of these, 168 received respiratory support via a tabletop NIV device as a step-up rescue therapy. Their mean age was 54 years, and 83% were men. Diabetes mellitus (78%) and hypertension (44%) were the commonest comorbidities. Treatment was successful with tabletop NIV in 77% (129/168) of the patients; of them, 41% (69/168) received treatment with continuous positive airway pressure alone and 36% (60/168) received additional increased inspiratory pressure via the bilevel positive air pressure mode. Conclusion Respiratory support using the tabletop NIV device was an effective and economical treatment for coronavirus disease 2019 acute respiratory distress syndrome. Further studies are required to assess the appropriate time of initiation for maximal benefits and judicious utilization of resources.
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Key Words
- ARDS, acute respiratory distress syndrome
- BPAP, bilevel positive airway pressure
- CARDS, coronavirus disease 2019 acute respiratory distress syndrome
- COVID-19, coronavirus disease 19
- CPAP, continuous positive airway pressure
- HFNO, high-flow nasal oxygen
- ICU, intensive care unit
- IMV, invasive mechanical ventilation
- IPAP, inspiratory positive airway pressure
- NIV, noninvasive ventilation
- PEEP, positive end-expiratory pressure
- RIMCU, respiratory intermediate care unit
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Affiliation(s)
| | - Nadesan Priya
- Department of Pulmonary Medicine, Christian Medical College, Vellore, India
| | - Avinash Anil Nair
- Department of Respiratory Medicine, Christian Medical College, Vellore, India
| | | | - Amith Balachandran
- Department of General Medicine, Christian Medical College, Vellore, India
| | - Tina George
- Department of General Medicine, Christian Medical College, Vellore, India
| | | | | | - Ramya Iyadurai
- Department of General Medicine, Christian Medical College, Vellore, India
| | - Selwyn Selva Kumar
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | - Anand Zachariah
- Department of General Medicine, Christian Medical College, Vellore, India
| | - Bhagteshwar Singh
- Department of Infectious Diseases, Christian Medical College, Vellore, India
- Department of Clinical Infection Microbiology and Immunology, Institute for Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | | | - Richa Gupta
- Department of Respiratory Medicine, Christian Medical College, Vellore, India
| | - Jefferson Daniel
- Department of Pulmonary Medicine, Christian Medical College, Vellore, India
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Park S, Suh ES. Home mechanical ventilation: back to basics. Acute Crit Care 2020; 35:131-141. [PMID: 32907307 PMCID: PMC7483009 DOI: 10.4266/acc.2020.00514] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/27/2020] [Indexed: 11/30/2022] Open
Abstract
Over recent decades, the use of home mechanical ventilation (HMV) has steadily increased worldwide, with varying prevalence in different countries. The key indication for HMV is chronic respiratory failure with alveolar hypoventilation (e.g., neuromuscular and chest wall disease, obstructive airway diseases, and obesity-related respiratory failure). Most modern home ventilators are pressure-targeted and have sophisticated modes, alarms, and graphics, thereby facilitating optimization of the ventilator settings. However, different ventilators have different algorithms for tidal volume estimation and leak compensation, and there are also several different circuit configurations. Hence, a basic understanding of the fundamentals of HMV is of paramount importance to healthcare workers taking care of patients with HMV. When choosing a home ventilator, they should take into account many factors, including the current condition and prognosis of the primary disease, the patient’s daily performance status, time (hr/day) needed for ventilator support, family support, and financial costs. In this review, to help readers understand the basic concepts of HMV use, we describe the indications for HMV and the factors that influence successful delivery, including interface, circuits, ventilator accessories, and the ventilator itself.
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Affiliation(s)
- Sunghoon Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eui-Sik Suh
- Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
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Piper A, Pépin JL, Hart N. Positive airway pressure in obesity hypoventilation syndrome: is it worth it? Thorax 2020; 75:439-440. [PMID: 32217782 DOI: 10.1136/thoraxjnl-2019-214403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Amanda Piper
- Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Jean Louis Pépin
- HP2 laboratory, INSERM U1042, University Grenoble Alpes, and EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Nicholas Hart
- Lane Fox Respiratory Service, Guy's & St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Research Centre, Centre for Human Applied Physiological Science, School of Medical and Biomedical Sciences, King's College London, London, United Kingdom
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Patout M, Dantoing E, De Marchi M, Hart N, Murphy PB, Cuvelier A. Step‐down from non‐invasive ventilation to continuous positive airway pressure: A better phenotyping is required. Respirology 2019; 25:456. [DOI: 10.1111/resp.13746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 10/23/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Maxime Patout
- EA3830‐GRHV, Institute for Research and Innovation in Biomedicine (IRIB)Normandie Univ, UNIRouen Rouen France
- Pulmonary, Thoracic Oncology and Respiratory Intensive Care DepartmentRouen University Hospital Rouen France
| | - Edouard Dantoing
- Pulmonary, Thoracic Oncology and Respiratory Intensive Care DepartmentRouen University Hospital Rouen France
| | - Marielle De Marchi
- Pulmonary, Thoracic Oncology and Respiratory Intensive Care DepartmentRouen University Hospital Rouen France
| | - Nicholas Hart
- Lane Fox Respiratory ServiceGuy's and St Thomas' NHS Foundation Trust London UK
- Centre for Human and Applied Physiological SciencesKing's College London London UK
- NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London London UK
| | - Patrick B. Murphy
- Lane Fox Respiratory ServiceGuy's and St Thomas' NHS Foundation Trust London UK
- Centre for Human and Applied Physiological SciencesKing's College London London UK
- NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London London UK
| | - Antoine Cuvelier
- EA3830‐GRHV, Institute for Research and Innovation in Biomedicine (IRIB)Normandie Univ, UNIRouen Rouen France
- Pulmonary, Thoracic Oncology and Respiratory Intensive Care DepartmentRouen University Hospital Rouen France
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Chu CM, Piper A. Non-invasive ventilation: A glimpse into the future. Respirology 2019; 24:1140-1142. [PMID: 31625248 DOI: 10.1111/resp.13710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/24/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Chung-Ming Chu
- Division of Respiratory Medicine, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, China
| | - Amanda Piper
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Central Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Cuvelier A, Taillé C. [Facing to patients with obesity: A paradigm to modify]. Rev Mal Respir 2019; 36:915-918. [PMID: 31521431 DOI: 10.1016/j.rmr.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 11/29/2022]
Affiliation(s)
- A Cuvelier
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, UPRES EA 3830, université de Rouen, CHU de Rouen, 76031 Rouen cedex, France.
| | - C Taillé
- Service de pneumologie, centre de référence constitutif des maladies pulmonaires rares, UMR 1152, université de Paris, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France
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