scholarly journals Assistive technologies for home NIV in patients with COPD: feasibility and positive experience with remote-monitoring and volume-assured auto-EPAP NIV mode

2021 ◽  
Vol 8 (1) ◽  
pp. e000828
Author(s):  
Grace McDowell ◽  
Maksymilian Sumowski ◽  
Hannah Toellner ◽  
Sophia Karok ◽  
Ciara O'Dwyer ◽  
...  
Keyword(s):  
Remote Monitoring ◽  
Assistive Technologies ◽  
Chronic Obstructive ◽  
Service Model ◽  
Data Set ◽  
Obstructive Pulmonary Disease ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Set Up

BackgroundOutcomes for patients with chronic obstructive pulmonary disease (COPD) with persistent hypercapnic respiratory failure are improved by long-term home non-invasive ventilation (NIV). Provision of home-NIV presents clinical and service challenges. The aim of this study was to evaluate outcomes of home-NIV in hypercapnic patients with COPD who had been set-up at our centre using remote-monitoring and iVAPS-autoEPAP NIV mode (Lumis device, ResMed).MethodsRetrospective analysis of a data set of 46 patients with COPD who commenced remote-monitored home-NIV (AirView, ResMed) between February 2017 and January 2018. Events including time to readmission or death at 12 months were compared with a retrospectively identified cohort of 27 patients with hypercapnic COPD who had not been referred for consideration of home-NIV.ResultsThe median time to readmission or death was significantly prolonged in patients who commenced home-NIV (median 160 days, 95% CI 69.38 to 250.63) versus the comparison cohort (66 days, 95% CI 21.9 to 110.1; p<0.01). Average time to hospital readmission was 221 days (95% CI, 47.77 to 394.23) and 70 days (95% CI, 55.31 to 84.69; p<0.05), respectively. Median decrease in bicarbonate level of 4.9 mmol/L (p<0.0151) and daytime partial pressure of carbon dioxide 2.2 kPa (p<0.032) in home-NIV patients with no required increase in nurse home visits is compatible with effectiveness of this service model. Median reduction of 14 occupied bed days per annum was observed per patient who continued home-NIV throughout the study period (N=32).ConclusionThese findings demonstrate the feasibility and provide initial utility data for a technology-assisted service model for the provision of home-NIV therapy for patients with COPD.

scholarly journals Two-way remote monitoring allows effective and realistic provision of home-NIV to COPD patients with persistent hypercapnia.

2020 ◽  
Author(s):  
Grace McDowell ◽  
Maksymilian Sumowski ◽  
Hannah Toellner ◽  
Sophia Karok ◽  
Ciara O'Dwyer ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Remote Monitoring ◽  
Chronic Obstructive ◽  
Control Cohort ◽  
Obstructive Pulmonary Disease ◽  
Hypercapnic Respiratory Failure ◽  
Non Invasive ◽  
Copd Patients ◽  
Non Invasive Ventilation

Background Outcomes for chronic obstructive pulmonary disease (COPD) patients with persistent hypercapnic respiratory failure are improved by long-term home non-invasive ventilation (NIV). Provision of home-NIV presents clinical and service challenges. The aim of this study was to assess outcomes of home-NIV in hypercapnic COPD patients managed remotely. Methods Retrospective analysis of a dataset of 46 COPD patients with persistent hypercapnic respiratory failure who commenced home-NIV managed by two-way remote monitoring (Lumis, AirView, ResMed) between February 2017 and January 2018. The primary outcome of this study was time to readmission or death at 12 months in patients receiving home-NIV versus a retrospectively identified control cohort of 27 patients with hypercapnic COPD who had not been referred for home-NIV. Results The median time to readmission or death was significantly prolonged in patients who commenced home-NIV (median 160 days, 95% CI 69.38-250.63) versus the control cohort (66 days, 95% CI 21.9-110.1; p<0.01). Average time to hospital readmission was 221 days (95% CI, 47.77-394.23) and 70 days (95% CI, 55.31-84.69; p<0.05), respectively. Median decrease in bicarbonate level of 4.9mmol/L (p<0.0151) and daytime PCO2 2.2kPa (p<0.032) demonstrate efficacy of home-NIV. A median reduction of 14 occupied bed days per annum versus previous year prior to NIV was observed per patient who continued home-NIV throughout the study period (N=32). Conclusion These findings confirm the benefits of home-NIV in clinical practice and support the use of two-way remote monitoring as a feasible solution to managing the delivery of home-NIV for COPD patients with persistent hypercapnia.

Long-term oxygen therapy/ventilation and cardiovascular outcomes in chronic lung and respiratory diseases

ESC CardioMed ◽  
2018 ◽  
pp. 1047-1050
Author(s):  
Anita K. Simonds
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Oxygen Therapy ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Obstructive Pulmonary Disease ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Long Term Oxygen Therapy

There is a well-established evidence base for prescribing long-term oxygen therapy in chronic obstructive pulmonary disease, and this has been extrapolated to management of hypoxaemia in other conditions such as interstitial lung disease and chronic pulmonary hypertension. Non-invasive ventilation reduces mortality in chronic stable hypercapnic patients with chronic obstructive pulmonary disease and those who remain persistently hypercapnic following an acute infective exacerbation. In patients with some neuromuscular disorders, non-invasive ventilation may increase survival and quality of life significantly. Few cardiovascular endpoints have been monitored systematically in these populations.

scholarly journals Is Outpatient Control of Long-Term Non-Invasive Ventilation Feasible in Chronic Obstructive Pulmonary Disease Patients?

Respiration ◽  
2017 ◽  
Vol 95 (3) ◽  
pp. 154-160 ◽  
Author(s):  
Sarah Bettina Schwarz ◽  
Jens Callegari ◽  
Christine Hamm ◽  
Wolfram Windisch ◽  
Friederike Sophie Magnet
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Obstructive Pulmonary Disease ◽  
Non Invasive ◽  
Non Invasive Ventilation

scholarly journals Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: long term survival and predictors of in-hospital outcome

Thorax ◽  
2001 ◽  
Vol 56 (9) ◽  
pp. 708-712
Author(s):  
P K Plant ◽  
J L Owen ◽  
M W Elliott
Keyword(s):  
Respiratory Rate ◽  
Standard Treatment ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Term Survival ◽  
Obstructive Pulmonary Disease ◽  
Long Term Survival ◽  
Non Invasive ◽  
Non Invasive Ventilation

BACKGROUNDNon-invasive ventilation (NIV) reduces the need for intubation and the mortality associated with an exacerbation of chronic obstructive pulmonary disease (COPD). This study aimed to identify factors that could be used to stratify patients according to their risk of requiring invasive mechanical ventilation. The second aim was to determine the long term survival of patients treated with and without NIV.METHODSIn this prospective multicentre randomised controlled trial 118 patients were allocated to standard treatment and 118 to NIV between November 1996 and September 1998. Arterial blood gas tensions and respiratory rate were recorded at enrolment and after 1 and 4 hours. Prognostic factors were identified using logistic regression analysis. All patients were followed until death or 1 January 1999.RESULTSAt enrolment the H+ concentration (OR 1.22 per nmol/l, 95% CI 1.09 to 1.37, p<0.01) and Paco2 (OR 1.14 per kPa, 95% CI 1.14 to 1.81, p<0.01) were associated with treatment failure. Allocation to NIV was protective (OR 0.39, 95% CI 0.19 to 0.80). After 4 hours of treatment improvement in acidosis (OR 0.89 per nmol/l, 95% CI 0.82 to 0.97, p<0.01) and fall in respiratory rate (OR 0.92 per breaths/min, 95% CI 0.84 to 0.99, p=0.04) were associated with success. Median length of survival was 16.8 months in those treated with NIV and 13.4 months in those receiving standard treatment (p=0.12). The trend in improved survival was attributable to prevention of death during the index admission.CONCLUSIONInitial pH and hypercapnia can be used to stratify groups of patients according to their risk of needing intubation. NIV reduces this risk and progress should be monitored using change in respiratory rate and pH. The long term survival after NIV is sufficiently good to render treatment appropriate.

Sign in / Sign up

Export Citation Format

Share Document