Day-to-Day Variability of Parameters Recorded by Home Noninvasive Positive Pressure Ventilation for Detection of Severe Acute Exacerbations in COPD

Telemonitoring in Non-invasive Ventilation

Telemonitoring in non-invasive ventilation is constantly evolving to enable follow-up of adults and children. Depending on the device and manufacturer, different ventilator variables are displayed on web-based platforms. However, high-granularity measurement is not always available remotely, which precludes breath-by-breath waveforms and precise monitoring of nocturnal gas exchange. Therefore, telemonitoring is mainly useful for monitoring utilization of the device, leaks, and respiratory events. Coordinated relationships between patients, homecare providers, and hospital teams are necessary to transform available data into diagnosis and actions. Telemonitoring is time and cost-consuming. The balance between cost, workload, and clinical benefit should be further evaluated.

Mask interfaces and devices for home noninvasive ventilation in children

Home noninvasive ventilation (NIV), including continuous (CPAP) and bilevel (BPAP) positive airway pressure, is increasingly used in children worldwide. In this narrative review, we present a comprehensive summary of the equipment available for home NIV in pediatrics, excluding neonates. NIV may be challenging in young children, as the majority of the equipment has been developed for adults. Regarding the interfaces, only a few masks have been specifically developed for young children in recent years, while older children may benefit from a large variety of interfaces. Even though much progress has been made, skin injuries are still present, and need to be managed rapidly. Several studies addressed the management of the side effects, but recent studies are lacking regarding orofacial anomalies. No recent study reported the available interfaces for young children and the strategies for an optimal mask fit. Regarding the devices, an adapted NIV device to pediatrics that allows an adequate patient's breathing detection should guarantee optimal ventilatory efficiency and monitoring of NIV. A close follow-up and regular monitoring should be mandatory to rule out the potential issues, optimize NIV therapy and ascertain the efficacy of NIV. However, studies are lacking to guide the choice of devices in young children and the optimal management of home NIV in pediatrics. We summarized the characteristics of the different interfaces available for young children and the limitations of NIV devices. We finally addressed potential areas for future research on long-term home NIV in children.

Monitoring Systems in Home Ventilation

Non-invasive ventilation (NIV) is commonly used at home for patient with nocturnal hypoventilation caused by a chronic respiratory failure. Monitoring NIV is required to optimize the ventilator settings when the lung condition changes over time, and to detect common problems such as unintentional leaks, upper airway obstructions, and patient–ventilator asynchronies. This review describes the accuracy and limitations of the data recorded by the ventilator. To efficiently interpret this huge amount of data, clinician assess the daily use and regularity of NIV utilization, the unintentional leaks and their repartition along the NIV session, the apnea–hypopnea index and the flow waveform, and the patient–ventilator synchrony. Nocturnal recordings of gas exchanges are also required to detect nocturnal alveolar hypoventilation. This review describes the indication, validity criteria, and interpretation of nocturnal oximetry and transcutaneous capnography. Polygraphy and polysomnography are indicated in specific cases to characterize upper airway obstruction. Telemonitoring of the ventilator is a useful tool that should be integrated in the monitoring strategy. The technical solution, information, and limitations are discussed. In conclusion, a basic monitoring package is recommended for all patients complemented by advanced monitoring for specific cases.

Machine-learning based feature selection for a non-invasive breathing change detection

BACKGROUND

Chronic Obstructive Pulmonary Disease (COPD) is one of the top 10 causes of death worldwide, representing a major public health problem. Researchers have been looking for new technologies and methods for patient monitoring with the intention of an early identification of acute exacerbation events. Many of these works have been focusing in breathing rate variation, while achieving unsatisfactory sensitivity and/or specificity. This study aims to identify breathing features that better describe respiratory pattern changes in a short-term adjustment of the load-capacity-drive balance, using exercising data.

RESULTS

Under any tested circumstances, breathing rate alone leads to poor capability of classifying rest and effort periods. The best performances were achieved when using Fourier coefficients or when combining breathing rate with the signal amplitude and/or ARIMA coefficients.

CONCLUSIONS

Breathing rate alone is a quite poor feature in terms of prediction of breathing change and the addition of any of the other proposed features improves the classification power. Thus, the combination of features may be considered for enhancing exacerbation prediction methods based in the breathing signal.

TRIAL REGISTRATION

ClinicalTrials NCT03753386. Registered 27 November 2018, https://clinicaltrials.gov/show/NCT03753386.