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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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Soleimani F, Donker DW, Oppersma E, Duiverman ML. Clinical evidence and technical aspects of innovative technology and monitoring of chronic NIV in COPD: a narrative review. Expert Rev Respir Med 2024; 18:513-526. [PMID: 39138642 DOI: 10.1080/17476348.2024.2384024] [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: 03/29/2024] [Accepted: 07/21/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION Chronic nocturnal noninvasive ventilation (NIV) improves outcomes in COPD patients with chronic hypercapnic respiratory failure. The aim of chronic NIV in COPD is to control chronic hypercapnic respiratory insufficiency and reduce symptoms of nocturnal hypoventilation, thereby improving quality of life. Chronic NIV care is more and more offered exclusively at home, enabling promising outcomes in terms of patient and caregiver satisfaction, hospital care consumption and cost reduction. Yet, to achieve and maintain optimal ventilation, during adaptation and follow-up, effective feasible (home) monitoring poses a significant challenge. AREAS COVERED Comprehensive monitoring of COPD patients receiving chronic NIV requires integrating data from ventilators and assessment of the patient's status including gas exchange, sleep quality, and patient-reported outcomes. The present article describes the physiological background of monitoring during NIV and aims to provide an overview of existing methods for monitoring, assessing their reliability and clinical relevance. EXPERT OPINION Patients on chronic NIV are 'ideal' candidates for home monitoring; the advantages of transforming hospital to home care are huge for patients and caregivers and for healthcare systems facing increasing patient numbers. Despite the multitude of available monitoring methods, identifying and characterizing the most relevant parameters associated with optimal patient well-being remains unclear.
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Affiliation(s)
- F Soleimani
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - D W Donker
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E Oppersma
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - M L Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
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V. S. O. N. Cavalcante A, Fonseca JD, Araujo Cruz HR, Nascimento VF, Santana Silva JP, Lins CA, Bernardes Neto SCG, Lima ÍND. Neural respiratory drive during maximal voluntary ventilation in individuals with hypertension: A case-control study. PLoS One 2024; 19:e0305044. [PMID: 38861578 PMCID: PMC11166319 DOI: 10.1371/journal.pone.0305044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 05/22/2024] [Indexed: 06/13/2024] Open
Abstract
Neural respiratory drive (NRD) is measured using a non-invasive recording of respiratory electromyographic signal. The parasternal intercostal muscle can assess the imbalance between the load and capacity of respiratory muscles and presents a similar pattern to diaphragmatic activity. We aimed to analyze the neural respiratory drive in seventeen individuals with hypertension during quite breathing and maximal voluntary ventilation (MVV) (103.9 ± 5.89 vs. 122.6 ± 5 l/min) in comparison with seventeen healthy subjects (46.5 ± 2.5 vs. 46.4 ± 2.4 years), respectively. The study protocol was composed of quite breathing during five minutes, maximum inspiratory pressure followed by maximal ventilatory ventilation (MVV) was recorded once for 15 seconds. Anthropometric measurements were collected, weight, height, waist, hip, and calf circumferences, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), BMI, and conicity index (CI). Differences between groups were analyzed using the unpaired t-test or Mann-Whitney test to determine the difference between groups and moments. A significance level of 5% (p<0,05) was adopted for all statistical analyses. The group of individuals with hypertension presented higher values when compared to the healthy group for neural respiratory drive (EMGpara% 17.9±1.3 vs. 13.1±0.8, p = 0.0006) and neural respiratory drive index (NRDi (AU) 320±25 vs. 205.7±15,p = 0.0004) during quiet breathing and maximal ventilatory ventilation (EMGpara% 29.3±2.7 vs. 18.3±0.8, p = 0.000, NRDi (AU) 3140±259.4 vs. 1886±73.1,p<0.0001), respectively. In conclusion, individuals with hypertension presented higher NRD during quiet breathing and maximal ventilatory ventilation when compared to healthy individuals.
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Affiliation(s)
- Andressa V. S. O. N. Cavalcante
- Faculdade de Ciências da Saúde do Trairi (FACISA), Programa de Pós-Graduação em Ciências da Reabilitação, Santa Cruz, Rio Grande do Norte, Brazil
| | - Jéssica Danielle Fonseca
- Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Helen Rainara Araujo Cruz
- Faculdade de Ciências da Saúde do Trairi (FACISA), Laboratório de Motricidade e Fisiologia Humana, Santa Cruz, Rio Grande do Norte, Brazil
| | - Viviane Fabrícia Nascimento
- Faculdade de Ciências da Saúde do Trairi (FACISA), Laboratório de Motricidade e Fisiologia Humana, Santa Cruz, Rio Grande do Norte, Brazil
| | - João Pedro Santana Silva
- Faculdade de Ciências da Saúde do Trairi (FACISA), Laboratório de Motricidade e Fisiologia Humana, Santa Cruz, Rio Grande do Norte, Brazil
| | - Caio Alano Lins
- Faculdade de Ciências da Saúde do Trairi (FACISA), Programa de Pós-Graduação em Ciências da Reabilitação, Santa Cruz, Rio Grande do Norte, Brazil
| | - Saint-Clair Gomes Bernardes Neto
- Faculdade de Ciências da Saúde do Trairi (FACISA), Programa de Pós-Graduação em Ciências da Reabilitação, Santa Cruz, Rio Grande do Norte, Brazil
| | - Íllia Nadinne Dantas Lima
- Faculdade de Ciências da Saúde do Trairi (FACISA), Programa de Pós-Graduação em Ciências da Reabilitação, Santa Cruz, Rio Grande do Norte, Brazil
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Sauer J, Graßhoff J, Carbon NM, Koch WM, Weber-Carstens S, Rostalski P. Automated characterization of patient-ventilator interaction using surface electromyography. Ann Intensive Care 2024; 14:32. [PMID: 38407643 PMCID: PMC10897101 DOI: 10.1186/s13613-024-01259-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/04/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Characterizing patient-ventilator interaction in critically ill patients is time-consuming and requires trained staff to evaluate the behavior of the ventilated patient. METHODS In this study, we recorded surface electromyography ([Formula: see text]) signals from the diaphragm and intercostal muscles and esophageal pressure ([Formula: see text]) in mechanically ventilated patients with ARDS. The sEMG recordings were preprocessed, and two different algorithms (triangle algorithm and adaptive thresholding algorithm) were used to automatically detect inspiratory patient effort. Based on the detected inspirations, major asynchronies (ineffective, auto-, and double triggers and double efforts), delayed and synchronous triggers were computationally classified. Reverse triggers were not considered in this study. Subsequently, asynchrony indices were calculated. For the validation of detected efforts, two experts manually annotated inspiratory patient activity in [Formula: see text], blinded toward each other, the [Formula: see text] signals, and the algorithmic results. We also classified patient-ventilator interaction and calculated asynchrony indices with manually detected inspirations in [Formula: see text] as a reference for automated asynchrony classification and asynchrony index calculation. RESULTS Spontaneous breathing activity was recognized in 22 out of the 36 patients included in the study. Evaluation of the accuracy of the algorithms using 3057 inspiratory efforts in [Formula: see text] demonstrated reliable detection performance for both methods. Across all datasets, we found a high sensitivity (triangle algorithm/adaptive thresholding algorithm: 0.93/0.97) and a high positive predictive value (0.94/0.89) against expert annotations in [Formula: see text]. The average delay of automatically detected inspiratory onset to the [Formula: see text] reference was [Formula: see text]79 ms/29 ms for the two algorithms. Our findings also indicate that automatic asynchrony index prediction is reliable. For both algorithms, we found the same deviation of [Formula: see text] to the [Formula: see text]-based reference. CONCLUSIONS Our study demonstrates the feasibility of automating the quantification of patient-ventilator asynchrony in critically ill patients using noninvasive sEMG. This may facilitate more frequent diagnosis of asynchrony and support improving patient-ventilator interaction.
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Affiliation(s)
- Julia Sauer
- Institute for Electrical Engineering in Medicine, Universität zu Lübeck, Ratzeburger Allee 160, Lübeck, 23562, Germany.
| | - Jan Graßhoff
- Institute for Electrical Engineering in Medicine, Universität zu Lübeck, Ratzeburger Allee 160, Lübeck, 23562, Germany
- Fraunhofer IMTE, Fraunhofer Research Institution for Individualized and Cell-Based Medical Engineering, Lübeck, Germany
| | - Niklas M Carbon
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Department of Anesthesiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Uniklinikum Erlangen, Erlangen, Germany
| | - Willi M Koch
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Philipp Rostalski
- Institute for Electrical Engineering in Medicine, Universität zu Lübeck, Ratzeburger Allee 160, Lübeck, 23562, Germany
- Fraunhofer IMTE, Fraunhofer Research Institution for Individualized and Cell-Based Medical Engineering, Lübeck, Germany
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Jonkman AH, Warnaar RSP, Baccinelli W, Carbon NM, D'Cruz RF, Doorduin J, van Doorn JLM, Elshof J, Estrada-Petrocelli L, Graßhoff J, Heunks LMA, Koopman AA, Langer D, Moore CM, Nunez Silveira JM, Petersen E, Poddighe D, Ramsay M, Rodrigues A, Roesthuis LH, Rossel A, Torres A, Duiverman ML, Oppersma E. Analysis and applications of respiratory surface EMG: report of a round table meeting. Crit Care 2024; 28:2. [PMID: 38166968 PMCID: PMC10759550 DOI: 10.1186/s13054-023-04779-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
Surface electromyography (sEMG) can be used to measure the electrical activity of the respiratory muscles. The possible applications of sEMG span from patients suffering from acute respiratory failure to patients receiving chronic home mechanical ventilation, to evaluate muscle function, titrate ventilatory support and guide treatment. However, sEMG is mainly used as a monitoring tool for research and its use in clinical practice is still limited-in part due to a lack of standardization and transparent reporting. During this round table meeting, recommendations on data acquisition, processing, interpretation, and potential clinical applications of respiratory sEMG were discussed. This paper informs the clinical researcher interested in respiratory muscle monitoring about the current state of the art on sEMG, knowledge gaps and potential future applications for patients with respiratory failure.
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Affiliation(s)
- A H Jonkman
- Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R S P Warnaar
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - W Baccinelli
- Netherlands eScience Center, Amsterdam, The Netherlands
| | - N M Carbon
- Department of Anesthesiology, Friedrich Alexander-Universität Erlangen-Nürnberg, Uniklinikum Erlangen, Erlangen, Germany
| | - R F D'Cruz
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J L M van Doorn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Elshof
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - L Estrada-Petrocelli
- Facultad de Ingeniería and Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT) - Sistema Nacional de Investigación (SNI), Universidad Latina de Panamá (ULATINA), Panama, Panama
| | - J Graßhoff
- Fraunhofer Research Institution for Individualized and Cell-Based Medical Engineering, Lübeck, Germany
| | - L M A Heunks
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A A Koopman
- Division of Paediatric Critical Care Medicine, Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - D Langer
- Research Group for Rehabilitation in Internal Disorders, Department of Rehabilitation Sciences, KU Leuven, 3000, Leuven, Belgium
| | - C M Moore
- Netherlands eScience Center, Amsterdam, The Netherlands
| | - J M Nunez Silveira
- Hospital Italiano de Buenos Aires, Unidad de Terapia Intensiva, Ciudad de Buenos Aires, Argentina
| | - E Petersen
- Technical University of Denmark (DTU), DTU Compute, 2800, Kgs. Lyngby, Denmark
| | - D Poddighe
- Research Group for Rehabilitation in Internal Disorders, Department of Rehabilitation Sciences, KU Leuven, 3000, Leuven, Belgium
| | - M Ramsay
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Rodrigues
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - L H Roesthuis
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Rossel
- Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - A Torres
- Institut de Bioenginyeria de Catalunya (IBEC), Barcelona Institute of Science and Technology (BIST) and Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Universitat Politècnica de Catalunya BarcelonaTech (UPC), Barcelona, Spain
| | - M L Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - E Oppersma
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands.
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Chatwin M, Hart N. International Survey of the Tools Used for Assessment, Monitoring and Management of Home Mechanical Ventilation Patients. J Clin Med 2023; 12:6803. [PMID: 37959266 PMCID: PMC10649660 DOI: 10.3390/jcm12216803] [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: 09/27/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND There are limited data reporting diagnostic practices, compared to clinical guidelines, for patients with chronic respiratory failure requiring home mechanical ventilation (HMV). There are no data detailing the current use of downloaded physiological monitoring data in day-to-day clinical practice during initiation and follow up of patients on HMV. This survey reports clinicians' practices, with a specific focus on the clinical approaches employed to assess, monitor and manage HMV patients. METHODS A web-based international survey was open between 1 January and 31 March 2023. RESULTS In total, 114 clinicians responded; 84% of the clinicians downloaded the internal physiological ventilator data when initiating and maintaining HMV patients, and 99% of the clinicians followed up with patients within 3 months. Adherence, leak and the apnea-hypopnea index were the three highest rated items. Oxygen saturation was used to support a diagnosis of nocturnal hypoventilation and was preferred over measurements of carbon dioxide. Furthermore, 78% of the clinicians reviewed data for the assessment of patient ventilator asynchrony (PVA), although the confidence reported in identifying certain PVAs was reported as unconfident or extremely unconfident. CONCLUSIONS This survey confirmed that clinical practice varies and often does not follow the current guidelines. Despite PVA being of clinical interest, its clinical relevance was not clear, and further research, education and training are required to improve clinical confidence.
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Affiliation(s)
- Michelle Chatwin
- Royal Brompton Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
- National Hospital for Neurology and Neurosurgery, University College London, London WC1N 3BG, UK
| | - Nicholas Hart
- Lane Fox Respiratory Service St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK;
- Lane Fox Clinical Respiratory Physiology Research Unit, Centre for Human and Applied Physiological Science, King’s College London, London SE1 7EH, UK
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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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Establishment and Application of a Patient-Ventilator Asynchrony Remote Network Platform for ICU Mechanical Ventilation: A Retrospective Study. J Clin Med 2023; 12:jcm12041570. [PMID: 36836113 PMCID: PMC9960909 DOI: 10.3390/jcm12041570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND In the process of mechanical ventilation, the problem of patient-ventilator asynchrony (PVA) is faced. This study proposes a self-developed remote mechanical ventilation visualization network system to solve the PVA problem. METHOD The algorithm model proposed in this study builds a remote network platform and achieves good results in the identification of ineffective triggering and double triggering abnormalities in mechanical ventilation. RESULT The algorithm has a sensitivity recognition rate of 79.89% and a specificity of 94.37%. The sensitivity recognition rate of the trigger anomaly algorithm was as high as 67.17%, and the specificity was 99.92%. CONCLUSIONS The asynchrony index was defined to monitor the patient's PVA. The system analyzes real-time transmission of respiratory data, identifies double triggering, ineffective triggering, and other anomalies through the constructed algorithm model, and outputs abnormal alarms, data analysis reports, and data visualizations to assist or guide physicians in handling abnormalities, which is expected to improve patients' breathing conditions and prognosis.
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Home High-Flow Oxygen Therapy Should Be Considered in Patients With COPD and Chronic Respiratory Failure. Arch Bronconeumol 2023; 59:5-6. [PMID: 36402702 DOI: 10.1016/j.arbres.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022]
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10
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Macías Paredes A, Alvarez JM, Pérez N, Puy C, Peñacoba P, Segura M, Antón A. Controlled cycles in spontaneous-timed noninvasive ventilation: Incidence and associated factors. Respir Med 2022; 204:107005. [DOI: 10.1016/j.rmed.2022.107005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 10/31/2022]
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11
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McCartney A, Phillips D, James M, Chan O, Neder JA, de-Torres JP, Domnik NJ, Crinion SJ. Ventilatory neural drive in chronically hypercapnic patients with COPD: effects of sleep and nocturnal noninvasive ventilation. Eur Respir Rev 2022; 31:31/165/220069. [PMID: 36130786 DOI: 10.1183/16000617.0069-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/29/2022] [Indexed: 11/05/2022] Open
Abstract
Sleep brings major challenges for the control of ventilation in humans, particularly the regulation of arterial carbon dioxide pressure (P aCO2 ). In patients with COPD, chronic hypercapnia is associated with increased mortality. Therefore, nocturnal high-level noninvasive positive-pressure ventilation (NIV) is recommended with the intention to reduce P aCO2 down to normocapnia. However, the long-term physiological consequences of P aCO2 "correction" on the mechanics of breathing, gas exchange efficiency and resulting symptoms (i.e. dyspnoea) remain poorly understood. Investigating the influence of sleep on the neural drive to breathe and its translation to the mechanical act of breathing is of foremost relevance to create a solid rationale for the use of nocturnal NIV. In this review, we critically discuss the mechanisms by which sleep influences ventilatory neural drive and mechanical consequences in healthy subjects and hypercapnic patients with advanced COPD. We then discuss the available literature on the effects of nocturnal NIV on ventilatory neural drive and respiratory mechanics, highlighting open avenues for further investigation.
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Affiliation(s)
| | - Devin Phillips
- Dept of Medicine, Queen's University, Kingston, ON, Canada
| | - Matthew James
- Dept of Medicine, Queen's University, Kingston, ON, Canada
| | - Olivia Chan
- Dept of Medicine, Queen's University, Kingston, ON, Canada
| | - J Alberto Neder
- Dept of Medicine, Queen's University, Kingston, ON, Canada.,Division of Respirology and Sleep Medicine, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Juan P de-Torres
- Dept of Medicine, Queen's University, Kingston, ON, Canada.,Division of Respirology and Sleep Medicine, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Nicolle J Domnik
- Dept of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Sophie J Crinion
- Dept of Medicine, Queen's University, Kingston, ON, Canada .,Division of Respirology and Sleep Medicine, Kingston Health Sciences Centre, Kingston, ON, Canada
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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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Letellier C, Lujan M, Arnal JM, Carlucci A, Chatwin M, Ergan B, Kampelmacher M, Storre JH, Hart N, Gonzalez-Bermejo J, Nava S. Patient-Ventilator Synchronization During Non-invasive Ventilation: A Pilot Study of an Automated Analysis System. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:690442. [PMID: 35047935 PMCID: PMC8757845 DOI: 10.3389/fmedt.2021.690442] [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: 04/02/2021] [Accepted: 05/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Patient-ventilator synchronization during non-invasive ventilation (NIV) can be assessed by visual inspection of flow and pressure waveforms but it remains time consuming and there is a large inter-rater variability, even among expert physicians. SyncSmart™ software developed by Breas Medical (Mölnycke, Sweden) provides an automatic detection and scoring of patient-ventilator asynchrony to help physicians in their daily clinical practice. This study was designed to assess performance of the automatic scoring by the SyncSmart software using expert clinicians as a reference in patient with chronic respiratory failure receiving NIV. Methods: From nine patients, 20 min data sets were analyzed automatically by SyncSmart software and reviewed by nine expert physicians who were asked to score auto-triggering (AT), double-triggering (DT), and ineffective efforts (IE). The study procedure was similar to the one commonly used for validating the automatic sleep scoring technique. For each patient, the asynchrony index was computed by automatic scoring and each expert, respectively. Considering successively each expert scoring as a reference, sensitivity, specificity, positive predictive value (PPV), κ-coefficients, and agreement were calculated. Results: The asynchrony index assessed by SynSmart was not significantly different from the one assessed by the experts (18.9 ± 17.7 vs. 12.8 ± 9.4, p = 0.19). When compared to an expert, the sensitivity and specificity provided by SyncSmart for DT, AT, and IE were significantly greater than those provided by an expert when compared to another expert. Conclusions:SyncSmart software is able to score asynchrony events within the inter-rater variability. When the breathing frequency is not too high (<24), it therefore provides a reliable assessment of patient-ventilator asynchrony; AT is over detected otherwise.
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Affiliation(s)
- Christophe Letellier
- Normandie Université - CORIA, Avenue de l'Université, Saint-Etienne du Rouvray, France
| | - Manel Lujan
- Servei de Pneumologia, Corporació Parc Taulí, Sabadell, Spain.,Departament de Medicina, Universitat Autònoma de Bellaterra, Barcelona, Spain
| | - Jean-Michel Arnal
- Service de Réanimation Polyvalente, Unité de Ventilation à domicile, Hôpital Sainte Musse, Toulon, France
| | - Annalisa Carlucci
- Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Pavia and Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
| | - Michelle Chatwin
- Clinical and Academic Department of Sleep and Breathing, Royal Brompton & Harefield, National Health Service Foundation Trust, London, United Kingdom
| | - Begum Ergan
- Division of Intensive Care, Department of Pulmonary and Critical Care, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Mike Kampelmacher
- Department of Pulmonology, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Jan Hendrik Storre
- Department of Pneumology, University Medical Hospital, Freiburg, Germany.,Pneumologie Solln, Munich, Germany
| | - Nicholas Hart
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jesus Gonzalez-Bermejo
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Soins de Suites et réhabilitation respiratoire-Département R3S, Paris, France
| | - Stefano Nava
- Respiratory and Critical Care, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), Bologna, Italy
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14
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Lalmolda C, Flórez P, Corral M, Hernández Voth A, Grimau C, Sayas J, Luján M. Does the Efficacy of High Intensity Ventilation in Stable COPD Depend on the Ventilator Model? A Bench-to-Bedside Study. Int J Chron Obstruct Pulmon Dis 2022; 17:155-164. [PMID: 35058690 PMCID: PMC8765713 DOI: 10.2147/copd.s327994] [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: 07/23/2021] [Accepted: 12/06/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose The European Task Force for chronic non-invasive ventilation in stable COPD recommends the use of high pressure-support (PS) level to maximize the decrease in PaCO2. It is possible that the ventilator model can influence the need for higher or lower pressure levels. Research Question To determine the differences between ventilators in a bench model with an increased inspiratory demand; and to compare the degree of muscular unloading measured by parasternal electromyogram (EMGpara) provided by the different ventilators in real patients with stable COPD. Patients and Methods Bench: four levels of increasing progressive effort were programmed. The response of nine ventilators to four levels of PS and EPAP of 5 cm H2O was studied. The pressure-time product was determined at 300 and 500 msec (PTP 300/500). Clinical Study The ventilators were divided into two groups, based on the result of the bench test. Severe COPD patients with non-invasive ventilation (NIV) were studied, randomly comparing the performance of one ventilator from each group. Muscle unloading was measured by the decrease in EMGpara from its baseline value. Results There were significant differences in PTP 300 and PTP 500 in the bench study. Based on these results, home ventilators were classified into two groups; group 1 included four models with higher PTP 300. Ten COPD patients were recruited for the clinical study. Group 1 ventilators showed greater muscle unloading at the same PS than group 2. Conclusion The scale of pressure support in NIV for high intensity ventilation may be influenced by the ventilator model. Clinical Trials.gov NCT03373175.
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Affiliation(s)
- Cristina Lalmolda
- Pneumology Department, Corporació Sanitària I Universitària Parc Taulí, Sabadell, Barcelona, Spain
- CIBERES, Centro de Investigación Biomédica en red, Mallorca, Spain
| | - Pablo Flórez
- Pneumology Department, Corporació Sanitària I Universitària Parc Taulí, Sabadell, Barcelona, Spain
| | - Marta Corral
- Pneumology Department, Hospital 12 de Octubre, Madrid, Spain
| | | | - Carles Grimau
- Pneumology Department, Corporació Sanitària I Universitària Parc Taulí, Sabadell, Barcelona, Spain
| | - Javier Sayas
- CIBERES, Centro de Investigación Biomédica en red, Mallorca, Spain
| | - Manel Luján
- Pneumology Department, Corporació Sanitària I Universitària Parc Taulí, Sabadell, Barcelona, Spain
- CIBERES, Centro de Investigación Biomédica en red, Mallorca, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
- Correspondence: Manel Luján Pneumology Department, Corporació Parc Taulí, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Campus de la UAB, Plaça Cívica, Bellaterra, 08193, Barcelona, SpainTel +34937231010 Email
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15
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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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16
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Suh ES, D'Cruz RF, Ramsay M, Steier J, Jolley CJ, Reilly CC, Hart N, Moxham J, Murphy PB, Rafferty GF. Second intercostal space electromyography as a measure of neural respiratory drive: Clinical utility and validity. Respir Physiol Neurobiol 2021; 290:103683. [PMID: 33971312 DOI: 10.1016/j.resp.2021.103683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/05/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Eui-Sik Suh
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rebecca F D'Cruz
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Michelle Ramsay
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joerg Steier
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Caroline J Jolley
- Centre for Human & Applied Physiological Sciences, King's College London, London, UK; King's College Hospital NHS Foundation Trust, London, UK
| | - Charles C Reilly
- Centre for Human & Applied Physiological Sciences, King's College London, London, UK; King's College Hospital NHS Foundation Trust, London, UK
| | - Nicholas Hart
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John Moxham
- Centre for Human & Applied Physiological Sciences, King's College London, London, UK; King's College Hospital NHS Foundation Trust, London, UK
| | - Patrick B Murphy
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gerrard F Rafferty
- Centre for Human & Applied Physiological Sciences, King's College London, London, UK.
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17
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Tagliabue G, Ji M, Suneby Jagers JV, Dean D, Lee W, Zuege DJ, Wilde ER, Easton PA. Intrinsic parasternal electromyogram is not captured by chest wall surface recording: Techniques and post inspiratory activity. Respir Physiol Neurobiol 2021; 288:103641. [PMID: 33607262 DOI: 10.1016/j.resp.2021.103641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Giovanni Tagliabue
- University of Calgary, Department of Critical Care Medicine, Calgary, Alberta, Canada
| | - Michael Ji
- University of Calgary, Department of Critical Care Medicine, Calgary, Alberta, Canada
| | - Jenny V Suneby Jagers
- University of Calgary, Department of Critical Care Medicine, Calgary, Alberta, Canada
| | - Devin Dean
- Chinook Regional Hospital, Lethbridge, Alberta, Canada
| | - WooSurng Lee
- Department of Thoracic and Cardiovascular Surgery, Konkuk University, Chungju, Republic of Korea
| | - Dan J Zuege
- University of Calgary, Department of Critical Care Medicine, Calgary, Alberta, Canada
| | - Eric R Wilde
- Chinook Regional Hospital, Lethbridge, Alberta, Canada
| | - Paul A Easton
- University of Calgary, Department of Critical Care Medicine, Calgary, Alberta, Canada.
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18
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Parasternal electromyography as a surrogate measure of neural respiratory drive: Practical application and validity of surface and implanted fine wire methods. Respir Physiol Neurobiol 2021; 287:103602. [PMID: 33503498 DOI: 10.1016/j.resp.2020.103602] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/09/2020] [Accepted: 12/13/2020] [Indexed: 11/22/2022]
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19
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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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20
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"Tricks and tips for home mechanical ventilation" Home mechanical ventilation: set-up and monitoring protocols. Pulmonology 2020; 27:144-150. [PMID: 32912752 DOI: 10.1016/j.pulmoe.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 11/22/2022] Open
Abstract
In this part of the review series "Tricks and tips for home mechanical ventilation", we will discuss the evidence with regard to the place and manner of home mechanical ventilation initiation and follow-up. Outsourcing more and more of this chronic care to the home situation is a big challenge for the future: especially for the home situation, monitoring has to be non-invasive, reliable and easy to use, data security needs to be ensured, signals need to be integrated and preferably automatically processed and algorithms need to be developed based on clinically relevant outcomes.
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21
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Maarouf A, Domanski U, Schröder M, Franke KJ, Nilius G. Respiratorische Ereigniserkennung unter nichtinvasiver Beatmung (NIV) in Abhängigkeit von der genutzten Flowmessung. SOMNOLOGIE 2020. [DOI: 10.1007/s11818-020-00261-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Zusammenfassung
Hintergrund
Beim chronisch hyperkapnischem Atemversagen stellt die nächtliche nichtinvasive Beatmung (NIV) die Standardtherapie dar. Die Einstellung auf die NIV erfordert jedoch viel Erfahrung. Nur eine Polysomnografie (PSG) im Schlaflabor ermöglicht die genaue Analyse von residualen Obstruktionen der oberen Atemwege, zentralen Apnoen, Triggerfehlfunktionen und Leckagen. Die Flowmessung unter NIV ist technisch jedoch nicht einfach, insbesondere da normierte Schnittstellen zur Einbindung der Respiratoren in die PSG fehlen.
Ziel der Arbeit
Vergleich eines Druck‑/Flow-Monitors mit den Signalen aus den Schnittstellen der Respiratoren bezüglich der Erkennung sowohl von Apnoen/Hypopnoen als auch von NIV-spezifischen Ereignissen in der PSG.
Methoden
Retrospektiv wurden 20 Aufzeichnungen von Patienten unter NIV, die unter einem standardisierten Protokoll aufgezeichnet worden waren, erneut verblindet ausgewertet. Es erfolgte ein Vergleich der Auswertung dreier verschiedener Verfahren der Flowmessung (effortbasiert, Staudruckmessung, Schnittstelle) hinsichtlich der Häufigkeit von respiratorischen Ereignissen.
Ergebnisse
Durch eine einfach zu integrierende Staudruckmessung mittels Druck‑/Flow-Monitor waren signifikant weniger Ereignisse diagnostizierbar, als wenn der Flow über die Abdomen- und Thoraxgurte oder über die Schnittstelle zu den Respiratoren ermittelt wurde. Auch die NIV-induzierten Ereignisse wie Fehltriggerungen oder Leckagen ließen sich nur mittels der Schnittstelle zuverlässig erkennen.
Schlussfolgerung
Eine Messung des Flows mit einem Standard Druck‑/Flow-Monitor bietet keine ausreichend nachvollziehbaren Ergebnisse. Eine Einbindung des Beatmungsgeräts in die PSG über eine Schnittstelle ist daher zu fordern.
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22
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Mandal S, Ramsay M, Suh ES, Harding R, Thompson A, Douiri A, Moxham J, Murphy PB, Hart N. External heated humidification during non-invasive ventilation set up: results from a pilot cross-over clinical trial. Eur Respir J 2020; 55:13993003.01126-2019. [PMID: 32366486 DOI: 10.1183/13993003.01126-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 01/25/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Swapna Mandal
- Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, King's Health Partners, London, UK.,King's College London, School of Life Sciences, Centre for Human and Applied Physiological, London, UK.,Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Michelle Ramsay
- Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, King's Health Partners, London, UK.,King's College London, School of Life Sciences, Centre for Human and Applied Physiological, London, UK.,Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Eui-Sik Suh
- Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, King's Health Partners, London, UK.,King's College London, School of Life Sciences, Centre for Human and Applied Physiological, London, UK.,Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rachel Harding
- Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, King's Health Partners, London, UK.,King's College London, School of Life Sciences, Centre for Human and Applied Physiological, London, UK.,Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - April Thompson
- Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, King's Health Partners, London, UK.,King's College London, School of Life Sciences, Centre for Human and Applied Physiological, London, UK.,Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Abdel Douiri
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - John Moxham
- King's College London, School of Life Sciences, Centre for Human and Applied Physiological, London, UK
| | - Patrick Brian Murphy
- Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, King's Health Partners, London, UK.,King's College London, School of Life Sciences, Centre for Human and Applied Physiological, London, UK.,Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicholas Hart
- Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, King's Health Partners, London, UK .,King's College London, School of Life Sciences, Centre for Human and Applied Physiological, London, UK.,Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
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23
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Ergan B, Oczkowski S, Rochwerg B, Carlucci A, Chatwin M, Clini E, Elliott M, Gonzalez-Bermejo J, Hart N, Lujan M, Nasilowski J, Nava S, Pepin JL, Pisani L, Storre JH, Wijkstra P, Tonia T, Boyd J, Scala R, Windisch W. European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD. Eur Respir J 2019; 54:13993003.01003-2019. [DOI: 10.1183/13993003.01003-2019] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/13/2019] [Indexed: 02/07/2023]
Abstract
BackgroundWhile the role of acute non-invasive ventilation (NIV) has been shown to improve outcome in acute life-threatening hypercapnic respiratory failure in COPD, the evidence of clinical efficacy of long-term home NIV (LTH-NIV) for management of COPD is less. This document provides evidence-based recommendations for the clinical application of LTH-NIV in chronic hypercapnic COPD patients.Materials and methodsThe European Respiratory Society task force committee was composed of clinicians, methodologists and experts in the field of LTH-NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology. The GRADE Evidence to Decision framework was used to formulate recommendations. A number of topics were addressed under a narrative format which provides a useful context for clinicians and patients.ResultsThe task force committee delivered conditional recommendations for four actionable PICO (target population-intervention-comparator-outcome) questions, 1) suggesting for the use of LTH-NIV in stable hypercapnic COPD; 2) suggesting for the use of LTH-NIV in COPD patients following a COPD exacerbation requiring acute NIV 3) suggesting for the use of NIV settings targeting a reduction in carbon dioxide and 4) suggesting for using fixed pressure support as first choice ventilator mode.ConclusionsManaging hypercapnia may be an important intervention for improving the health outcome of COPD patients with chronic respiratory failure. The task force conditionally supports the application of LTH-NIV to improve health outcome by targeting a reduction in carbon dioxide in COPD patients with persistent hypercapnic respiratory failure. These recommendations should be applied in clinical practice by practitioners that routinely care for chronic hypercapnic COPD patients.
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24
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Ishak A, Ramsay M, Hart N, Steier J. BPAP is an effective second‐line therapy for obese patients with OSA failing regular CPAP: A prospective observational cohort study. Respirology 2019; 25:443-448. [DOI: 10.1111/resp.13674] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/26/2019] [Accepted: 07/04/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Athanasius Ishak
- Faculty of Life Sciences and Medicine, Centre for Human and Applied Physiological Science (CHAPS)King's College London London UK
- Lane Fox Respiratory UnitGuy's and St Thomas' NHS Foundation Trust London UK
| | - Michelle Ramsay
- Lane Fox Respiratory UnitGuy's and St Thomas' NHS Foundation Trust London UK
| | - Nicholas Hart
- Faculty of Life Sciences and Medicine, Centre for Human and Applied Physiological Science (CHAPS)King's College London London UK
- Lane Fox Respiratory UnitGuy's and St Thomas' NHS Foundation Trust London UK
| | - Joerg Steier
- Faculty of Life Sciences and Medicine, Centre for Human and Applied Physiological Science (CHAPS)King's College London London UK
- Lane Fox Respiratory UnitGuy's and St Thomas' NHS Foundation Trust London UK
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25
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Borel JC, Gonzalez-Bermejo J. Is it still relevant to consider polysomnography as essential for noninvasive ventilation titration? Eur Respir J 2019; 53:53/5/1900619. [DOI: 10.1183/13993003.00619-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 04/03/2019] [Indexed: 11/05/2022]
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26
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Gonzalez-Bermejo J, Janssens JP, Rabec C, Perrin C, Lofaso F, Langevin B, Carlucci A, Lujan M. Framework for patient-ventilator asynchrony during long-term non-invasive ventilation. Thorax 2019; 74:715-717. [DOI: 10.1136/thoraxjnl-2018-213022] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 11/04/2022]
Abstract
Episodes of patient-ventilator asynchrony (PVA) occur during acute and chronic non-invasive positive pressure ventilation (NIV). In long-term NIV, description and quantification of PVA is not standardised, thus limiting assessment of its clinical impact. The present report provides a framework for a systematic analysis of polygraphic recordings of patients under NIV for the detection and classification of PVA validated by bench testing. The algorithm described uses two different time windows: rate asynchrony and intracycle asynchrony. This approach should facilitate further studies on prevalence and clinical impact of PVA in long-term NIV.
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27
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Mu S, Rautela L, Howard ME, Hannan L. Autocycling During Noninvasive Positive Pressure Ventilation Producing a Prolonged Severe Apnea and Syncope. J Clin Sleep Med 2019; 15:663-665. [PMID: 30952221 DOI: 10.5664/jcsm.7738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 01/09/2019] [Indexed: 11/13/2022]
Abstract
ABSTRACT Autocycling is a form of patient-ventilator asynchrony that can occur during mechanical ventilation. In the case described, autocycling during noninvasive ventilation led to severe hyperventilation and subsequently produced a prolonged central apnea that resulted in syncope. This case represents the first description of a severe adverse event from autocycling during noninvasive ventilation.
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Affiliation(s)
- Susana Mu
- Austin Health, Heidelberg, Victoria, Australia.,Northern Health, Epping, Victoria, Australia
| | - Linda Rautela
- Austin Health, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Victorian Respiratory Support Service, Heidelberg, Victoria, Australia
| | - Mark E Howard
- Austin Health, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Victorian Respiratory Support Service, Heidelberg, Victoria, Australia.,University of Melbourne, Parkville, Victoria, Australia
| | - Liam Hannan
- Austin Health, Heidelberg, Victoria, Australia.,Northern Health, Epping, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Victorian Respiratory Support Service, Heidelberg, Victoria, Australia
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28
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Hannan LM, Rautela L, Berlowitz DJ, McDonald C, Cori JM, Sheers N, Chao C, O'Donoghue FJ, Howard ME. Randomised controlled trial of polysomnographic titration of noninvasive ventilation. Eur Respir J 2019; 53:13993003.02118-2018. [DOI: 10.1183/13993003.02118-2018] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/03/2019] [Indexed: 12/23/2022]
Abstract
Noninvasive ventilation (NIV) settings determined during wakefulness may produce patient–ventilator asynchrony (PVA) during sleep, causing sleep disruption and limiting tolerance. This study investigated whether NIV titrated with polysomnography (PSG) is associated with less PVA and sleep disruption than therapy titrated during daytime alone.Treatment-naive individuals referred for NIV were randomised to control (daytime titration followed by sham polysomnographic titration) or PSG (daytime titration followed by polysomnographic titration) groups. Primary outcomes were PVA and arousal indices on PSG at 10 weeks. Secondary outcomes included adherence, gas exchange, symptoms and health-related quality of life (HRQoL).In total, 60 participants were randomised. Most (88.3%) had a neuromuscular disorder and respiratory muscle weakness but minor derangements in daytime arterial blood gases. PVA events were less frequent in those undergoing polysomnographic titration (median (interquartile range (IQR)): PSG 25.7 (12–68) events·h−1versuscontrol 41.0 (28–182) events·h−1; p=0.046), but arousals were not significantly different (median (IQR): PSG 11.4 (9–19) arousals·h−1versuscontrol 14.6 (11–19) arousals·h−1; p=0.258). Overall adherence was not different except in those with poor early adherence (<4 h·day−1) who increased their use after polysomnographic titration (mean difference: PSG 95 (95% CI 29–161) min·day−1versuscontrol −23 (95% CI −86–39) min·day−1; p=0.01). Arterial carbon dioxide tension, somnolence and sleep quality improved in both groups. There were no differences in nocturnal gas exchange or overall measures of HRQoL.NIV titrated with PSG is associated with less PVA but not less sleep disruption when compared with therapy titrated during daytime alone.
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29
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One Plus One Might not make Two: Patient-Ventilator Interaction in Non-Invasive Ventilation. Who Does What? Arch Bronconeumol 2019; 55:403-406. [PMID: 30846203 DOI: 10.1016/j.arbres.2019.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/11/2019] [Accepted: 01/30/2019] [Indexed: 11/20/2022]
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30
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Borel J, Palot A, Patout M. Technological advances in home non‐invasive ventilation monitoring: Reliability of data and effect on patient outcomes. Respirology 2019; 24:1143-1151. [DOI: 10.1111/resp.13497] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/31/2018] [Accepted: 01/09/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Jean‐Christian Borel
- Département recherche et DéveloppementAGIR à dom Meylan France
- Faculté de MédecineINSERM U 1042, HP2 Laboratory, Université Joseph Fourier Grenoble France
| | - Alain Palot
- Clinique des Bronches, Allergies et du SommeilAssistance Publique Hôpitaux de Marseille Marseille France
- INSERM U1067CNRS UMR 7333 Aix Marseille Université Marseille France
| | - Maxime Patout
- Normandie UnivUNIRouen, EA3830‐GRHV, Institute for Research and Innovation in Biomedicine (IRIB) Rouen France
- Service de Pneumologie, Oncologie thoracique et Soins Intensifs RespiratoiresRouen University Hospital Rouen France
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31
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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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32
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van der Leest S, Duiverman ML. High-intensity non-invasive ventilation in stable hypercapnic COPD: Evidence of efficacy and practical advice. Respirology 2018; 24:318-328. [PMID: 30500099 DOI: 10.1111/resp.13450] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/30/2018] [Accepted: 11/11/2018] [Indexed: 01/12/2023]
Abstract
Patients with end-stage chronic obstructive pulmonary disease (COPD) frequently develop chronic hypercapnic respiratory failure (CHRF), with disabling symptoms and poor survival. The use of long-term nocturnal non-invasive ventilation (NIV) to treat CHRF in COPD has long been subject of debate due to conflicting evidence. However, since the introduction of high-intensity NIV (HI-NIV) in COPD, physiological and clinical benefits have been shown. HI-NIV refers to specific ventilator settings used for NIV aimed at achieving normocapnia or the lowest partial arterial carbon dioxide pressure (PaCO2 ) values as possible. This review will provide an overview of existing evidence of the efficacy of HI-NIV stable COPD patients with CHRF. Secondly, we will discuss hypotheses underlying NIV benefit in stable hypercapnic COPD, providing insight into better patient selection and hopefully more individually titrated HI-NIV. Finally, we will provide practical advice on how to initiate and follow-up patients on HI-NIV, with special emphasis on monitoring that should be available during the initiation and follow-up of HI-NIV, and will discuss more extended monitoring techniques that could improve HI-NIV treatment in the future.
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Affiliation(s)
- Sietske van der Leest
- Cardiovascular and Respiratory Physiology Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands.,Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
| | - Marieke L Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
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33
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Adler D, Janssens JP. The Pathophysiology of Respiratory Failure: Control of Breathing, Respiratory Load, and Muscle Capacity. Respiration 2018; 97:93-104. [PMID: 30423557 DOI: 10.1159/000494063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 09/24/2018] [Indexed: 11/19/2022] Open
Abstract
The purpose of this review is to provide an overview on how interactions between control of breathing, respiratory load, and muscle function may lead to respiratory failure. The mechanisms involved vary according to the underlying pathology, but respiratory failure is most often the result of an imbalance between the muscular pump and the mechanical load placed upon it. Changes in respiratory drive and response to CO2 seem to be important contributors to the pathophysiology of respiratory failure. Inspiratory muscle dysfunction is also frequent but is not a mandatory prerequisite to respiratory failure since increased load may also be sufficient to precipitate it. It is crucial to recognize these interactions to be able to timeously establish patients on mechanical ventilation and adapt the ventilator settings to their respiratory system physiology.
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Affiliation(s)
- Dan Adler
- Division of Lung Diseases, University Hospitals of Geneva and Geneva Medical School, Geneva, Switzerland,
| | - Jean-Paul Janssens
- Division of Lung Diseases, University Hospitals of Geneva and Geneva Medical School, Geneva, Switzerland
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34
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Aarrestad S, Qvarfort M, Kleiven AL, Tollefsen E, Skjønsberg OH, Janssens JP. Diagnostic accuracy of simple tools in monitoring patients with chronic hypoventilation treated with non-invasive ventilation; a prospective cross-sectional study. Respir Med 2018; 144:30-35. [DOI: 10.1016/j.rmed.2018.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 12/14/2022]
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35
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Ciorba C, Gonzalez-Bermejo J, Salva MAQ, Annane D, Orlikowski D, Lofaso F, Prigent H. Flow and airway pressure analysis for detecting ineffective effort during mechanical ventilation in neuromuscular patients. Chron Respir Dis 2018; 16:1479972318790267. [PMID: 30064272 PMCID: PMC6302971 DOI: 10.1177/1479972318790267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Ineffective efforts (IEs) are among the most common types of patient–ventilator
asynchrony. The objective of this study is to validate IE detection during
expiration using pressure and flow signals, with respiratory effort detection by
esophageal pressure (Pes) measurement as the reference, in patients with
neuromuscular diseases (NMDs). We included 10 patients diagnosed with chronic
respiratory failure related to NMD. Twenty-eight 5-minute recordings of daytime
ventilation were studied for IE detection. Standard formulas were used to
calculate sensitivity, specificity, positive predictive value (PPV), and
negative predictive value (NPV) of IE detection using pressure and flow signals
compared to Pes measurement. Mean sensitivity and specificity of flow and
pressure signal-based IE detection versus Pes measurement were 97.5% ± 5.3% and
91.4% ± 13.7%, respectively. NPV was 98.1% ± 8.2% and PPV was 67.6% ± 33.8%.
Spearman’s rank correlation coefficient indicated a moderately significant
correlation between frequencies of IEs and controlled cycles (ρ
= 0.50 and p = 0.01). Among respiratory cycles, 311 (11.2%)
were false-positive IEs overall. Separating false-positive IEs according to
their mechanisms, we observed premature cycling in 1.2% of cycles, delayed
ventilator triggering in 0.1%, cardiac contraction in 9.2%, and upper airway
instability during expiration in 0.3%. Using flow and pressure signals to detect
IEs is a simple and rapid method that produces adequate data to support clinical
decisions.
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Affiliation(s)
- Cristina Ciorba
- 1 Service Physiologie et Explorations-Fonctionnelles, INSERM CIC 1429, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - Jesus Gonzalez-Bermejo
- 2 Service de Pneumologie et Réanimation Médicale ( Département " R3S"), INSERM UMRS1158, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Maria-Antonia Quera Salva
- 1 Service Physiologie et Explorations-Fonctionnelles, INSERM CIC 1429, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - Djillali Annane
- 3 Service de Réanimation médicale et unité de ventilation à domicile, INSERM CIC 1429, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - David Orlikowski
- 3 Service de Réanimation médicale et unité de ventilation à domicile, INSERM CIC 1429, AP-HP, Hôpital Raymond Poincaré, Garches, France.,4 INSERM U 1179, Hôpital Raymond Poincaré, Université de Versailles Saint-Quentin-en-Yvelines, Garches, France
| | - Frédéric Lofaso
- 1 Service Physiologie et Explorations-Fonctionnelles, INSERM CIC 1429, AP-HP, Hôpital Raymond Poincaré, Garches, France.,4 INSERM U 1179, Hôpital Raymond Poincaré, Université de Versailles Saint-Quentin-en-Yvelines, Garches, France
| | - Hélène Prigent
- 1 Service Physiologie et Explorations-Fonctionnelles, INSERM CIC 1429, AP-HP, Hôpital Raymond Poincaré, Garches, France.,4 INSERM U 1179, Hôpital Raymond Poincaré, Université de Versailles Saint-Quentin-en-Yvelines, Garches, France
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36
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Garofalo E, Bruni A, Pelaia C, Liparota L, Lombardo N, Longhini F, Navalesi P. Recognizing, quantifying and managing patient-ventilator asynchrony in invasive and noninvasive ventilation. Expert Rev Respir Med 2018; 12:557-567. [DOI: 10.1080/17476348.2018.1480941] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Eugenio Garofalo
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Andrea Bruni
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Corrado Pelaia
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Luisa Liparota
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Nicola Lombardo
- Otolaryngology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Federico Longhini
- Anesthesia and Intensive Care, Sant’Andrea Hospital, Vercelli, Italy
| | - Paolo Navalesi
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
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37
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Shah NM, D'Cruz RF, Murphy PB. Update: non-invasive ventilation in chronic obstructive pulmonary disease. J Thorac Dis 2018; 10:S71-S79. [PMID: 29445530 DOI: 10.21037/jtd.2017.10.44] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) remains a common cause of morbidity and mortality worldwide. Patients with COPD and respiratory failure, whether acute or chronic have a poorer prognosis than patients without respiratory failure. Non-invasive ventilation (NIV) has been shown to be a useful tool in both the acute hospital and chronic home care setting. NIV has been well established as the gold standard therapy for acute decompensated respiratory failure complicating an acute exacerbation of COPD with reduced mortality and intubation rates compared to standard therapy. However, NIV has been increasingly used in other clinical situations such as for weaning from invasive ventilation and to palliate symptoms in patients not suitable for invasive ventilation. The equivocal evidence for the use of NIV in chronic hypercapnic respiratory failure complicating COPD has recently been challenged with data now supporting a role for therapy in selected subgroups of patients. Finally the review will discuss the emerging role of high flow humidified therapy to support or replace NIV in certain clinical situation.
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Affiliation(s)
- Neeraj Mukesh Shah
- Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rebecca Francesca D'Cruz
- Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,National Institute for Health Research (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 Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
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38
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Ramsay M. Patient ventilator asynchrony and sleep disruption during non-invasive ventilation. J Thorac Dis 2018; 10:S80-S85. [PMID: 29445531 DOI: 10.21037/jtd.2017.11.31] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patient-ventilator asynchrony (PVA) are a common phenomenon affecting all patients receiving long-term domiciliary ventilation. The interruption of synchrony between the patient and the ventilator has been reported to be a possible cause of nocturnal sleep disruption leaking to arousals, awakenings and reduced periods of stage 3 and REM sleep overnight. The cause of PVA is multi-factorial driven frequently by leak at the interface, changing respiratory breathing patterns and changes in sleep stages. It currently remains unclear as to whether the PVA is the cause of sleep fragmentation or if PVA is purely a marker of unsuccessful ventilatory control, patient discomfort and underlying sleep disruption.
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39
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Onofri A, Patout M, Kaltsakas G, Lhuillier E, Mushemi-Blake S, Arbane G, Pengo MF, Marino P, Steier J. Neural respiratory drive and cardiac function in patients with obesity hypoventilation syndrome following initiation of non-invasive ventilation. J Thorac Dis 2018; 10:S135-S143. [PMID: 29445537 DOI: 10.21037/jtd.2017.12.129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Chronic hypercapnic respiratory failure (HRF) in obesity hypoventilation syndrome (OHS) is commonly treated using non-invasive ventilation (NIV). We hypothesised that treatment of OHS would improve neural respiratory drive index (NRDI) and cardiac function. Methods Fourteen patients (8 females) with OHS, who were admitted for initiation of domiciliary NIV, were prospectively studied. Patients had (mean ± SD): age (53±10 years), body mass index (BMI) (50.1±10.8 kg/m2), and pCO2 (7.3±0.9 kPa). NRDI was assessed by surface electromyogram of the parasternal intercostals. Cardiac function was assessed by transthoracic echocardiography (TTE). All measurements were performed at baseline, 6 weeks, and 3 months. Results NRDI improved on day one following NIV set-up comparing to baseline (484.2±214.8 vs. 316.5±106.5 AU) and this improvement was maintained at 6 weeks (369.1±173.2 AU) and at 3 months (351.2±167.1 AU) (P=0.004). No significant differences were identified in terms of cardiac function between baseline and 3 months [tricuspid annular plane systolic excursion (TAPSE) (24.6±5.8 vs. 23.0±4.0 mm, P=0.317); systolic pulmonary artery (PA) pressures (36.7±15.2 vs. 44.5±23.9 mmHg, P=0.163]. Conclusions NIV improves NRDI in patients with OHS, while the cardiac function over a three-month period remains unchanged.
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Affiliation(s)
- Angelo Onofri
- Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Maxime Patout
- Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Normandie Univ, UNIRouen, EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB) and Rouen University Hospital, Service de Pneumologie, Oncologie thoracique et Soins Intensifs Respiratoires, Rouen, France
| | - Georgios Kaltsakas
- Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Elodie Lhuillier
- Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Normandie Univ, UNIRouen, EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB) and Rouen University Hospital, Service de Pneumologie, Oncologie thoracique et Soins Intensifs Respiratoires, Rouen, France
| | | | - Gill Arbane
- Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Martino F Pengo
- Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Philip Marino
- Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Joerg Steier
- Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
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40
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Ghosh D, Elliott MW. Looking under the bonnet of patient-ventilator asynchrony during noninvasive ventilation: does it add value? ERJ Open Res 2017; 3:00136-2017. [PMID: 29255721 PMCID: PMC5731773 DOI: 10.1183/23120541.00136-2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/02/2017] [Indexed: 12/03/2022] Open
Abstract
Noninvasive ventilation (NIV) has significant advantages over invasive ventilation in certain situations, such as hypercapnic respiratory failure due to an acute exacerbation of chronic obstructive pulmonary disease (COPD), acute cardiogenic pulmonary oedema, respiratory failure in immunocompromised patients and weaning from invasive ventilation in patients with COPD, in terms of reducing mortality, duration of hospital stay, the need for intubation and infectious complications [1–5]. During noninvasive ventilation it is reasonable to try to abolish clinically apparent patient-ventilator asynchronies but the use of more invasive tests to detect subtle asynchronies cannot be justifiedhttp://ow.ly/rXoA30gCm8O
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41
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Zhu K, Rabec C, Gonzalez-Bermejo J, Hardy S, Aouf S, Escourrou P, Roisman G. Combined effects of leaks, respiratory system properties and upper airway patency on the performance of home ventilators: a bench study. BMC Pulm Med 2017; 17:145. [PMID: 29157220 PMCID: PMC5697337 DOI: 10.1186/s12890-017-0487-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 11/10/2017] [Indexed: 12/14/2022] Open
Abstract
Background Combined effects of leaks, mechanical property of respiratory system and upper airway (UA) patency on patient-ventilator synchrony (PVA) and the level of clinically “tolerable” leaks are not well established in home ventilators. Methods We comparatively assessed on a bench model, the highest leak level tolerated without inducing significant asynchrony (“critical leak”) in three home ventilators (Astral 150, Trilogy 100 and Vivo 60; noted as A150, T100 and V60 respectively) subjected to three simulated diseased respiratory conditions: chronic obstructive pulmonary disease (COPD), obesity hypoventilation (OHS) and neuromuscular disorders (NMD), with both open and closed UA. Also, total leak values in the device reports were compared to the bench-measured values. Results With open UA, all ventilators were able to avoid asynchrony up to a 30 L/min leak and even to 55 L/min in some cases. UA closure and respiratory diseases especially OHS influenced PVA. With closed UA, the critical leak of A150 and T100 remained higher than 55 L/min in COPD and OHS, while for V60 decreased to 41 and 33 L/min respectively. In NMD with closed UA, only T100 reached a high critical leak of 69 L/min. Besides, inspiratory trigger sensitivity change was often necessary to avoid PVA. Conclusions Home ventilators were able to avoid PVA in high-level leak conditions. However, asynchrony appeared in cases of abnormal mechanical properties of respiratory system or closed UA. In case of closed UA, the EPAP should be adjusted prior to the inspiratory trigger. Trial registration Not applicable. Electronic supplementary material The online version of this article (10.1186/s12890-017-0487-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kaixian Zhu
- Centre Explor, Air Liquide Healthcare, 28 rue d'Arcueil, 94250, Gentilly, France.
| | - Claudio Rabec
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre Hospitalier Universitaire Dijon Bourgogne, 14 rue Paul Gaffarel, F-21079, Dijon, France
| | - Jésus Gonzalez-Bermejo
- Sorbonne Universités, UPMC Univ Paris 6, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Service de Pneumologie et Réanimation Médicale (Département "R3S"), AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, F-75013, Paris, France
| | - Sébastien Hardy
- Centre Explor, Air Liquide Healthcare, 28 rue d'Arcueil, 94250, Gentilly, France
| | - Sami Aouf
- Centre Explor, Air Liquide Healthcare, 28 rue d'Arcueil, 94250, Gentilly, France
| | - Pierre Escourrou
- Service des Explorations Fonctionnelles Multidisciplinaires, AP-HP, Hôpital Antoine-Béclère, 157 rue de la Porte de Trivaux, 92140, Clamart, France
| | - Gabriel Roisman
- Service des Explorations Fonctionnelles Multidisciplinaires, AP-HP, Hôpital Antoine-Béclère, 157 rue de la Porte de Trivaux, 92140, Clamart, France
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Aarrestad S, Qvarfort M, Kleiven AL, Tollefsen E, Skjønsberg OH, Janssens JP. Sleep related respiratory events during non-invasive ventilation of patients with chronic hypoventilation. Respir Med 2017; 132:210-216. [DOI: 10.1016/j.rmed.2017.10.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/12/2017] [Accepted: 10/31/2017] [Indexed: 12/14/2022]
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Mandal S, Suh ES, Harding R, Vaughan-France A, Ramsay M, Connolly B, Bear DE, MacLaughlin H, Greenwood SA, Polkey MI, Elliott M, Chen T, Douiri A, Moxham J, Murphy PB, Hart N. Nutrition and Exercise Rehabilitation in Obesity hypoventilation syndrome (NERO): a pilot randomised controlled trial. Thorax 2017; 73:62-69. [DOI: 10.1136/thoraxjnl-2016-209826] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 08/06/2017] [Accepted: 09/11/2017] [Indexed: 11/03/2022]
Abstract
BackgroundRespiratory management of obesity hypoventilation syndrome (OHS) focusses on the control of sleep-disordered breathing rather than the treatment of obesity. Currently, there are no data from randomised trials of weight loss targeted rehabilitation programmes for patients with OHS.InterventionA 3-month multimodal hybrid inpatient–outpatient motivation, exercise and nutrition rehabilitation programme, in addition to non invasive ventilation (NIV), would result in greater per cent weight loss compared with standard care.MethodsA single-centre pilot randomised controlled trial allocated patients to either standard care or standard care plus rehabilitation. Primary outcome was per cent weight loss at 12 months with secondary exploratory outcomes of weight loss, exercise capacity and health-related quality of life (HRQOL) at the end of the rehabilitation programme to assess the intervention effect.ResultsThirty-seven patients (11 male, 59.8±12.7 years) with a body mass index of 51.1±7.7 kg/m2 were randomised. At 12 months, there was no between-group difference in per cent weight loss (mean difference −5.9% (95% CI −14.4% to 2.7%; p=0.17)). At 3 months, there was a greater per cent weight loss (mean difference −5% (95% CI −8.3% to −1.4%; p=0.007)), increased exercise capacity (6 min walk test 60 m (95% CI 29.5 to 214.5) vs 20 m (95% CI 11.5 to 81.3); p=0.036) and HRQL (mean difference SF-36 general health score (10 (95% CI 5 to 21.3) vs 0 (95% CI −5 to 10); p=0.02)) in the rehabilitation group.ConclusionIn patients with OHS, a 3-month comprehensive rehabilitation programme, in addition to NIV, resulted in improved weight loss, exercise capacity and QOL at the end of the rehabilitation period, but these effects were not demonstrated at 12 months, in part, due to the limited retention of patients at 12 months.Trial registration numberPre-results; NCT01483716.
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Influence of Parameter Selection in Fixed Sample Entropy of Surface Diaphragm Electromyography for Estimating Respiratory Activity. ENTROPY 2017. [DOI: 10.3390/e19090460] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Vrijsen B, Buyse B, Belge C, Vanpee G, Van Damme P, Testelmans D. Randomized cross-over trial of ventilator modes during non-invasive ventilation titration in amyotrophic lateral sclerosis. Respirology 2017; 22:1212-1218. [DOI: 10.1111/resp.13046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 01/31/2017] [Accepted: 02/02/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Bart Vrijsen
- Department of Pulmonology and Leuven University Centre for Sleep and Wake Disorders (LUCS); University Hospitals Leuven; Leuven Belgium
- Faculty of Kinesiology and Rehabilitation Sciences; KU Leuven; Leuven Belgium
| | - Bertien Buyse
- Department of Pulmonology and Leuven University Centre for Sleep and Wake Disorders (LUCS); University Hospitals Leuven; Leuven Belgium
- Department of Clinical and Experimental Medicine; KU Leuven; Leuven Belgium
| | - Catharina Belge
- Department of Pulmonology and Leuven University Centre for Sleep and Wake Disorders (LUCS); University Hospitals Leuven; Leuven Belgium
- Department of Clinical and Experimental Medicine; KU Leuven; Leuven Belgium
| | - Goele Vanpee
- Department of Pulmonology and Leuven University Centre for Sleep and Wake Disorders (LUCS); University Hospitals Leuven; Leuven Belgium
- Faculty of Kinesiology and Rehabilitation Sciences; KU Leuven; Leuven Belgium
| | - Philip Van Damme
- Department of Neurology; University Hospitals Leuven; Leuven Belgium
- Department of Neurosciences; KU Leuven - University of Leuven, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND); Leuven Belgium
| | - Dries Testelmans
- Department of Pulmonology and Leuven University Centre for Sleep and Wake Disorders (LUCS); University Hospitals Leuven; Leuven Belgium
- Department of Clinical and Experimental Medicine; KU Leuven; Leuven Belgium
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Duiverman ML, Huberts AS, van Eykern LA, Bladder G, Wijkstra PJ. Respiratory muscle activity and patient-ventilator asynchrony during different settings of noninvasive ventilation in stable hypercapnic COPD: does high inspiratory pressure lead to respiratory muscle unloading? Int J Chron Obstruct Pulmon Dis 2017; 12:243-257. [PMID: 28138234 PMCID: PMC5238808 DOI: 10.2147/copd.s119959] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction High-intensity noninvasive ventilation (NIV) has been shown to improve outcomes in stable chronic obstructive pulmonary disease patients. However, there is insufficient knowledge about whether with this more controlled ventilatory mode optimal respiratory muscle unloading is provided without an increase in patient–ventilator asynchrony (PVA). Patients and methods Ten chronic obstructive pulmonary disease patients on home mechanical ventilation were included. Four different ventilatory settings were investigated in each patient in random order, each for 15 min, varying the inspiratory positive airway pressure and backup breathing frequency. With surface electromyography (EMG), activities of the intercostal muscles, diaphragm, and scalene muscles were determined. Furthermore, pressure tracings were derived simultaneously in order to assess PVA. Results Compared to spontaneous breathing, the most pronounced decrease in EMG activity was achieved with the high-pressure settings. Adding a high breathing frequency did reduce EMG activity per breath, while the decrease in EMG activity over 1 min was comparable with the high-pressure, low-frequency setting. With high backup breathing frequencies less breaths were pressure supported (25% vs 97%). PVAs occurred more frequently with the low-frequency settings (P=0.017). Conclusion High-intensity NIV might provide optimal unloading of respiratory muscles, without undue increases in PVA.
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Affiliation(s)
- Marieke L Duiverman
- Department of Pulmonary Diseases and Home Mechanical Ventilation, University Medical Centre Groningen
| | | | | | - Gerrie Bladder
- Department of Pulmonary Diseases and Home Mechanical Ventilation, University Medical Centre Groningen
| | - Peter J Wijkstra
- Department of Pulmonary Diseases and Home Mechanical Ventilation, University Medical Centre Groningen
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Care Practices and Health-related Quality of Life for Individuals Receiving Assisted Ventilation. A Cross-National Study. Ann Am Thorac Soc 2016; 13:894-903. [DOI: 10.1513/annalsats.201509-590oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Vrijsen B, Testelmans D, Belge C, Vanpee G, Van Damme P, Buyse B. Patient-ventilator asynchrony, leaks and sleep in patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2016; 17:343-50. [DOI: 10.3109/21678421.2016.1170149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Bart Vrijsen
- Department of Pulmonology and Leuven University Centre for Sleep and Wake disorders (LUCS) - University Hospitals Leuven,
- Faculty of Kinesiology and Rehabilitation Sciences – KU Leuven,
| | - Dries Testelmans
- Department of Pulmonology and Leuven University Centre for Sleep and Wake disorders (LUCS) - University Hospitals Leuven,
- Department of Clinical and Experimental Medicine – KU Leuven,
| | - Catharina Belge
- Department of Pulmonology and Leuven University Centre for Sleep and Wake disorders (LUCS) - University Hospitals Leuven,
- Department of Clinical and Experimental Medicine – KU Leuven,
| | - Goele Vanpee
- Department of Pulmonology and Leuven University Centre for Sleep and Wake disorders (LUCS) - University Hospitals Leuven,
- Faculty of Kinesiology and Rehabilitation Sciences – KU Leuven,
| | - Philip Van Damme
- Department of Neurology – University Hospitals Leuven,
- Department of Neurosciences, KU Leuven – University of Leuven, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), and
- Laboratory of Neurobiology, Vesalius Research Centre, VIB, Leuven, Belgium
| | - Bertien Buyse
- Department of Pulmonology and Leuven University Centre for Sleep and Wake disorders (LUCS) - University Hospitals Leuven,
- Department of Clinical and Experimental Medicine – KU Leuven,
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Hodgson LE, Murphy PB. Update on clinical trials in home mechanical ventilation. J Thorac Dis 2016; 8:255-67. [PMID: 26904266 PMCID: PMC4739968 DOI: 10.3978/j.issn.2072-1439.2016.01.53] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/30/2015] [Indexed: 12/14/2022]
Abstract
Home mechanical ventilation (HMV) is an increasingly common intervention and is initiated for a range of pathological processes, including neuromuscular disease (NMD), chronic obstructive pulmonary disease (COPD) and obesity related respiratory failure. There have been important recent data published in this area, which helps to guide practice by indicating which populations may benefit from this intervention and the optimum method of setting up and controlling sleep disordered breathing. Recent superficially conflicting data has been published regarding HMV in COPD, with a trial in post-exacerbation patients suggesting no benefit, but in stable chronic hypercapnic patients suggesting a clear and sustained mortality benefit. The two studies are critiqued and the potential reasons for the differing results are discussed. Early and small trial data is frequently contradicted with larger randomised controlled trials and this has been the case with diaphragm pacing being shown to be potentially harmful in the latest data, confirming the importance of non-invasive ventilation (NIV) in NMD such as motor neurone disease. Advances in ventilator technology have so far appeared quicker than the clinical data to support their use; although small and often unblinded, the current data suggests equivalence to standard modes of NIV, but with potential comfort benefits that may enhance adherence. The indications for NIV have expanded since its inception, with an effort to treat sleep disordered breathing as a result of chronic heart failure (HF). The SERVE-HF trial has recently demonstrated no clear advantage to this technology and furthermore detected a potentially deleterious effect, with a worsening of all cause and cardiovascular mortality in the treated group compared to controls. The review serves to provide the reader with a critical review of recent advances in the field of sleep disordered breathing and HMV.
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