1
|
Steindal SA, Hofsø K, Aagaard H, Mariussen KL, Andresen B, Christensen VL, Heggdal K, Wallander Karlsen MM, Kvande ME, Kynø NM, Langerud AK, Ohnstad MO, Sørensen K, Larsen MH. Non-invasive ventilation in the care of patients with chronic obstructive pulmonary disease with palliative care needs: a scoping review. BMC Palliat Care 2024; 23:27. [PMID: 38287312 PMCID: PMC10823671 DOI: 10.1186/s12904-024-01365-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/19/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Patients with severe chronic obstructive pulmonary disease (COPD) could have palliative care (PC) needs because of unmet needs such as dyspnoea. This may lead to anxiety and may have an impact on patients' ability to perform daily activities of living. PC can be started when patients with COPD have unmet needs and can be provided alongside disease-modifying therapies. Non-invasive ventilation (NIV) could be an important measure to manage dyspnoea in patients with COPD in need of PC. A scoping review was conducted to gain an overview of the existing research and to identify knowledge gaps. The aim of this scoping review was to systematically map published studies on the use of NIV in patients with COPD with PC needs, including the perspectives and experiences of patients, families, and healthcare professionals (HCPs). METHODS This review was conducted following the framework of Arksey and O'Malley. The reporting of the review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. The review protocol was published. AMED, CINAHL, Embase, MEDLINE, PEDro, and PsycInfo were searched from inception to November 14, 2022. The included studies had to report the perspectives and experiences of COPD patients, relatives, and HCPs regarding NIV in the care of patients with COPD with PC needs. In pairs, the authors independently assessed studies' eligibility and extracted data. The data were organised thematically. The results were discussed in a consultation exercise. RESULTS This review included 33 papers from 32 studies. Four thematic groupings were identified: preferences and attitudes towards the use of NIV; patient participation in the decision-making process of NIV treatment; conflicting results on the perceived benefits and burdens of treatment; and heterogenous clinical outcomes in experimental studies. Patients perceived NIV as a 'life buoy' to keep them alive. Many patients wanted to take part in the decision-making process regarding NIV treatment but expressed varying degrees of inclusion by HCPs in such decision-making. Conflicting findings were identified regarding the perceived benefits and burdens of NIV treatment. Diversity in heterogeneous clinical outcomes were reported in experimental studies. CONCLUSIONS There is a need for more studies designed to investigate the effectiveness of NIV as a palliative measure for patients with COPD with PC needs using comprehensive outcomes. It is especially important to gain more knowledge on the experiences of all stakeholders in the use of home-based NIV treatment to these patients.
Collapse
Affiliation(s)
- Simen A Steindal
- Lovisenberg Diaconal University College, Lovisenberggt 15B, 0456, Oslo, Norway.
- Faculty of Health Sciences, VID Specialized University, Mail Box 184 Vinderen, 0319, Oslo, Norway.
| | - Kristin Hofsø
- Lovisenberg Diaconal University College, Lovisenberggt 15B, 0456, Oslo, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Hanne Aagaard
- Lovisenberg Diaconal University College, Lovisenberggt 15B, 0456, Oslo, Norway
| | - Kari L Mariussen
- Lovisenberg Diaconal University College, Lovisenberggt 15B, 0456, Oslo, Norway
| | - Brith Andresen
- Lovisenberg Diaconal University College, Lovisenberggt 15B, 0456, Oslo, Norway
- The Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Kristin Heggdal
- Faculty of Health Sciences, VID Specialized University, Mail Box 184 Vinderen, 0319, Oslo, Norway
| | | | - Monica E Kvande
- Lovisenberg Diaconal University College, Lovisenberggt 15B, 0456, Oslo, Norway
| | - Nina M Kynø
- Department of Nursing and Health Promotion, Acute and Critical Illness, Oslo Metropolitan University, Oslo, Norway
- Department of Pediatric and Adolescent Medicine, Division of Neonatal Intensive Care, Oslo University Hospital, Oslo, Norway
| | - Anne Kathrine Langerud
- Department of Nursing and Health Promotion, Acute and Critical Illness, Oslo Metropolitan University, Oslo, Norway
- Department of Post-Operative and Critical Care, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Mari Oma Ohnstad
- Lovisenberg Diaconal University College, Lovisenberggt 15B, 0456, Oslo, Norway
| | - Kari Sørensen
- Lovisenberg Diaconal University College, Lovisenberggt 15B, 0456, Oslo, Norway
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | | |
Collapse
|
2
|
Vitacca M, Asti G, Fiorenza D, Steinhilber G, Salvi B, Paneroni M. Hospital-Provider Company Network for Home Non-Invasive Ventilation: A Feasibility Pilot Study. Healthcare (Basel) 2024; 12:328. [PMID: 38338213 PMCID: PMC10855547 DOI: 10.3390/healthcare12030328] [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: 12/27/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
This study assessed the feasibility of implementing a hybrid hospital-provider company (PC) clinical pathway for patients with chronic respiratory failure (CRF) through the adaptation and follow-up of non-invasive ventilation (NIV). Over a 3-month period, a PC physiotherapist case manager oversaw the adaptation process, making adjustments as necessary, using remote monitoring and home visits. Outcome measures, including the number of patients enrolled, serious adverse events, hospitalizations, survival rates, professional time allocation, NIV adherence, nocturnal apnea-hypopnea, and oxygen saturation, Δ arterial carbon dioxide pressure (PaCO2), dyspnea, Short Physical Performance Battery (SPPB), exercise tolerance, quality of life, physical activity, and patient satisfaction, were collected. The recruitment rate was 74% (nineteen patients). Commonly reported adverse events included leakage, discomfort and sleep disturbance. Predominant interventions were four home visits (3; 4) and two NIV adjustments (1; 5). The overall program time commitment averaged 43.97 h per patient (being hospital 40 ± 11% and PC 60 ± 11%). Improvements in PaCO2, dyspnea, SPPB and exercise tolerance were observed by the third month. Adherence to NIV was high, with good or very good satisfaction with its use. This study demonstrates that a hybrid hospital-PC service for NIV adaptation and follow-up is not only feasible but also shows validity, reliability, and acceptability.
Collapse
Affiliation(s)
- Michele Vitacca
- Respiratory Rehabilitation Unit of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, BS, Italy; (G.A.); (D.F.); (G.S.); (B.S.); (M.P.)
| | | | | | | | | | | |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Weinreich UM, Storgaard LH. A Real-Life Study of Combined Treatment with Long-Term Non-Invasive Ventilation and High Flow Nasal Cannula in Patients with End-Stage Chronic Obstructive Lung Disease. J Clin Med 2023; 12:4485. [PMID: 37445520 DOI: 10.3390/jcm12134485] [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: 05/17/2023] [Revised: 06/26/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
Patients with end-stage chronic obstructive pulmonary disease (COPD) often develop persistent hypoxic or hypercapnic respiratory failure, or a combination of both. Ventilatory support, in terms of a long-term high-flow nasal cannula (LT-HFNC) and long-term non-invasive ventilation (LT-NIV), may be indicated. Often, clinicians choose either one or the other. This paper explores combined treatment with LT-HFNC and LT-NIV in a real-life setting. In total, 33 patients with COPD and persistent respiratory failure were included in this study. Of those, 17 were initiated on LT-HFNC and used it for 595 (374) days and 16 were initiated on LT-NIV and used it for 558 (479) days. On average, patients used respiratory support continuously for 908 (586) days. Baseline characteristics were comparable, apart from PaCO2 at first ventilatory support initiation (LT-HFNC/LT-NIV 7.1 (1.1) kPa/8.8 (0.9) kPa respectively (p = 0.002)). Both groups experienced a reduction in hospitalizations in the first twelve months after treatment initiation, compared to the twelve months before (LT-HFNC p = 0.022 and LT-NIV p = 0.014). In total, 25% of LT-NIV patients stopped treatment after HFNC initiation due to intolerance and 59% stopped LT-HFNC treatment 126 (36) days after LT-NIV initiation as monotherapy was sufficient. In 44% of these patients, LT-HFNC was re-initiated at the end of life. At the time of analysis, 70% of patients had died. In the last three months of life, patients stopped using LT-NIV, whereas 91% used LT-HFNC. In conclusion, the combined use of LT-NIV and LT-HFNC reduced hospitalizations in patients with COPD and persistent respiratory failure. The study indicates that LT-HFNC is well tolerated, and better tolerated than LT-NIV at the very end stages of COPD.
Collapse
Affiliation(s)
- Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, DK-9100 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, DK-9100 Aalborg, Denmark
| | - Line Hust Storgaard
- Department of Respiratory Diseases, Aalborg University Hospital, DK-9100 Aalborg, Denmark
| |
Collapse
|
5
|
Delorme M, Leotard A, Lebret M, Lefeuvre C, Hazenberg A, Pallero M, Nickol AH, Hannan LM, Boentert M, Yüksel A, Windisch W, Howard ME, Hart N, Wijkstra PJ, Prigent H, Pepin JL, Lofaso F, Khouri C, Borel JC. Effect of Intensity of Home Noninvasive Ventilation in Individuals With Neuromuscular and Chest Wall Disorders: A Systematic Review and Meta-Analysis of Individual Participant Data. Arch Bronconeumol 2023:S0300-2896(23)00156-4. [PMID: 37217384 DOI: 10.1016/j.arbres.2023.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Home noninvasive ventilation (NIV), targeting a reduction of carbon dioxide with a combination of sufficient inspiratory support and backup-rate improves outcomes in patients with chronic obstructive pulmonary disease. The aim of this systematic review with individual participant data (IPD) meta-analysis was to evaluate the effects of intensity of home NIV on respiratory outcomes in individuals with slowly progressive neuromuscular (NMD) or chest-wall disorders (CWD). METHODS Controlled, non-controlled and cohort studies indexed between January-2000 and December-2020 were sought from Medline, Embase and the Cochrane Central Register. Outcomes were diurnal PaCO2, PaO2, daily NIV usage, and interface type (PROSPERO-CRD 42021245121). NIV intensity was defined according to the Z-score of the product of pressure support (or tidal volume) and backup-rate. RESULTS 16 eligible studies were identified; we obtained IPD for 7 studies (176 participants: 113-NMD; 63-CWD). The reduction in PaCO2 was greater with higher baseline PaCO2. NIV intensity per se was not associated with improved PaCO2 except in individuals with CWD and the most severe baseline hypercapnia. Similar results were found for PaO2. Daily NIV usage was associated with improvement in gas exchange but not with NIV intensity. No association between NIV intensity and interface type was found. CONCLUSION Following home NIV initiation in NMD or CWD patients, no relationship was observed between NIV intensity and PaCO2, except in individuals with the most severe CWD. The amount of daily NIV usage, rather than intensity, is key to improving hypoventilation in this population during the first few months after introduction of therapy.
Collapse
Affiliation(s)
- Mathieu Delorme
- Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France; AFM-Téléthon, Direction des Actions Médicales, 91000 Evry, France
| | - Antoine Leotard
- Service de Physiologie et explorations fonctionnelles, GHU APHP - Paris Saclay - Hôpital Raymond Poincaré (APHP), 92380 Garches, France; Université Paris-Saclay, UVSQ, INSERM U1179, Equipe 3 «END:ICAP», 78000 Versailles, France
| | - Marius Lebret
- Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France
| | - Claire Lefeuvre
- Neurology Department, Raymond Poincaré University Hospital, Garches, APHP, France; Nord-Est-Ile-de-France Neuromuscular Reference Center, FHU PHENIX, France
| | - Anda Hazenberg
- University of Groningen, University Medical Center Groningen, Department of Pulmonology and Tuberculosis, Department of Home Mechanical Ventilation, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, GRIAC Research Institute, The Netherlands
| | - Mercedes Pallero
- Respiratory Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Annabel H Nickol
- Oxford Centre for Respiratory Medicine, Oxford University Hospital NHS Foundation Trust, Oxford OX3 7LE, UK; The Royal Brompton Hospital, London SW3 6NP, UK
| | - Liam M Hannan
- Department of Respiratory Medicine, Northern Health, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Melbourne, Australia; Dept of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Matthias Boentert
- Department of Neurology, Münster University Hospital (UKM), Münster, Germany; Department of Medicine, UKM-Marienhospital Steinfurt, Steinfurt, Germany
| | - Aycan Yüksel
- Ufuk University, Faculty of Medicine, Rıdvan Ege Hospital, Department of Pulmonology and Tuberculosis, Ankara, Turkey
| | - Wolfram Windisch
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln, gGmbH, Witten/Herdecke University, Germany
| | - Mark E Howard
- Institute for Breathing and Sleep, Melbourne, Australia; Dept of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Nicholas Hart
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK; Centre for Human and Applied Physiological Science, King's College London, London, UK
| | - Peter J Wijkstra
- University of Groningen, University Medical Center Groningen, Department of Pulmonology and Tuberculosis, Department of Home Mechanical Ventilation, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, GRIAC Research Institute, The Netherlands
| | - Hélène Prigent
- Service de Physiologie et explorations fonctionnelles, GHU APHP - Paris Saclay - Hôpital Raymond Poincaré (APHP), 92380 Garches, France; Université Paris-Saclay, UVSQ, INSERM U1179, Equipe 3 «END:ICAP», 78000 Versailles, France; FHU Phenix - GHU APHP - Paris Saclay - Hôpital Raymond Poincaré (APHP), 92380 Garches, France
| | - Jean-Louis Pepin
- HP2 (Hypoxia and Physio-Pathologies) Laboratory, Inserm (French National Institute of Health and Medical Research) U1300, University Grenoble Alpes, Grenoble, France; EFCR (Cardiovascular and Respiratory Function) Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Frederic Lofaso
- Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France; Service de Physiologie et explorations fonctionnelles, GHU APHP - Paris Saclay - Hôpital Raymond Poincaré (APHP), 92380 Garches, France
| | - Charles Khouri
- HP2 (Hypoxia and Physio-Pathologies) Laboratory, Inserm (French National Institute of Health and Medical Research) U1300, University Grenoble Alpes, Grenoble, France; Centre Régional de pharmacovigilance, Centre d'Investigation Clinique, CHU Grenoble Alpes, France
| | - Jean-Christian Borel
- HP2 (Hypoxia and Physio-Pathologies) Laboratory, Inserm (French National Institute of Health and Medical Research) U1300, University Grenoble Alpes, Grenoble, France; Research and Development Department, AGIR à dom Association, 36 Bd du Vieux Chêne, 38240 Meylan, France.
| |
Collapse
|
6
|
Greek Guidelines for the Management of COPD, a Proposal of a Holistic Approach Based on the needs of the Greek Community. J Pers Med 2022; 12:jpm12121997. [PMID: 36556218 PMCID: PMC9788491 DOI: 10.3390/jpm12121997] [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: 06/22/2022] [Revised: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 12/04/2022] Open
Abstract
Despite that COPD remains one of the most common respiratory diseases worldwide, it can be managed effectively with certain treatments and, more importantly, be prevented by the early implementation of various measures. The pathology and pathophysiology of this disease continue to be studied, with new pharmacological and invasive therapies emerging. In this consensus paper, the Working Group of the Hellenic Thoracic Society aimed to consolidate the up-to-date information and new advances in the treatment of COPD. Local and international data on its prevalence are presented, with revised strategies on the diagnostic approach and the evaluation of risk assessment and disease severity classification. Emphasis is placed on the management and therapy of patients with COPD, covering both common principles, specialized modalities, and algorithms to distinguish between home care and the need for hospitalization. Although pharmacological treatment is commonly recognized in COPD, an integrative approach of pulmonary rehabilitation, physical activity, patient education, and self-assessment should be encountered for a comprehensive treatment, prevention of exacerbations, and increased quality of life in patients.
Collapse
|
7
|
What is the impact of home non-invasive ventilation on the health-related quality of life of patients with chronic obstructive pulmonary disease? A systematic review. Qual Life Res 2022:10.1007/s11136-022-03310-z. [DOI: 10.1007/s11136-022-03310-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 12/03/2022]
|
8
|
Pierucci P, Crimi C, Carlucci A, Palma L, Noto A, Carpagnano GE, Scala R. Long-term home noninvasive ventilation (LTHNIV) in restrictive thoracic diseases: the Italian snapshot. Monaldi Arch Chest Dis 2022; 93. [PMID: 36445246 DOI: 10.4081/monaldi.2022.2459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/19/2022] [Indexed: 12/03/2022] Open
Abstract
Long-term home noninvasive ventilation (LTHNIV) in restrictive thoracic diseases was explored via the recently published international REINVENT ERS survey. The Italian subset of respondents (ITA-r), the highest above all participating nations, was analyzed and compared to non-Italian respondents (NO-ITA-r). The ITA-r represented 20% of the total answers examined. Ninety-four percent were physicians, whose half worked in a respiratory ICU (RICU). ITA-r mainly worked in community hospitals vs NO-ITA-r who are largely affiliated with university hospitals (p<0.0001). Amyotrophic lateral sclerosis (ALS) was considered the most common medical condition leading to NIV indication by both ITA-r and NO-ITA-r (93% vs 78%, p>0.5). A greater proportion of ITA-r considered MIP/MEP the most important test for NIV initiation as compared to NO-ITA-r (p<0.05). There was no significant difference for both ITA-r and NO-ITA-r as regards the other questions. This study illustrates Italian LTHNIV practices in patients with NMD and it shows some important differences with the other countries' practices but agreement in terms of goals to achieve, reasons to initiate NIV, and practices among the two communities.
Collapse
Affiliation(s)
- Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital; Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, "Aldo Moro" University of Bari .
| | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania.
| | - Annalisa Carlucci
- Department of Medicine and Surgery, University of Insubria, Varese-Como; ICS Maugeri IRCCS, Pavia.
| | - Lavinia Palma
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital; Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, "Aldo Moro" University of Bari .
| | - Alberto Noto
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Division of Anesthesia and Intensive Care, University of Messina, Policlinico "G. Martino", Messina; IPCF-CNR, Institute for Chemical and Physical Processes, National Research Council, Messina .
| | - Giovanna Elisiana Carpagnano
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital; Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, "Aldo Moro" University of Bari .
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo.
| |
Collapse
|
9
|
Ribeiro C, Jácome C, Oliveira P, Conde S, Windisch W, Nunes R. Patients experience regarding home mechanical ventilation in an outpatient setting. Chron Respir Dis 2022; 19:14799731221137082. [PMID: 36417310 PMCID: PMC9706049 DOI: 10.1177/14799731221137082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The patient's experience of treatment is a cornerstone of high-quality healthcare, along with clinical safety and effectiveness. We aimed to evaluate the patients' perspectives regarding home mechanical ventilation (HMV) follow up in an outpatient setting and ascertain differences between patients that started HMV in the outpatient setting compared to other settings. METHODS This cross-sectional study was conducted with patients with chronic respiratory failure under HMV in the Outpatient Ventilation Clinic. Patients filled in a patient experience questionnaire and the S3-NIV questionnaire. RESULTS The study included 235 patients (127, 54% male), median 70 [25-75 percentiles 64-76] years) and about half were adapted to HMV in the outpatient setting (117, 49.8%). Patients had a daily ventilator usage of 8.0 [6.0-10.0] hours and have been on ventilator for a median of 35.0 [12.0-66.0] months. Patients reported an overall good experience regarding education at initiation (209 [88.9%] considered the information given was enough), short time to adaptation [104 (44.3%) felt adapted after some hours], with perceived benefits (171 [72.8%] reported less shortness of breath, 158 (67.2%) improved quality of life and 150 (63.8%) less tiredness). Benefits overcame the treatment side-effects (158 [67.2%] reported mucosal dryness, 109 (46.4%) mask sores and 96 (40.9%) leaks). There was no difference in terms of reported health gains, side effects or time to adaptation between adaptation settings, but patients starting HMV in the outpatient setting reported better communication and education at adaptation. CONCLUSIONS Outpatient setting was perceived as a positive experience, both in HMV initiation and follow up, with good patient-physician communication leading to significant health reported gains, improvement of health status and well-being and good treatment adherence.
Collapse
Affiliation(s)
- Carla Ribeiro
- Pulmonology Department,
Centro
Hospitalar de Vila Nova de
Gaia/Espinho, Vila Nova de Gaia, Portugal,Carla Ribeiro, Pulmonology Department,
Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes s/n,
Vila Nova de Gaia 4434-502, Portugal.
| | - Cristina Jácome
- CINTESIS@RISE, MEDCIDS,
Faculty of
Medicine of the University of Porto,
Porto, Portugal
| | - Pedro Oliveira
- ISPUP-EPI Unit, Instituto de
Ciências Biomédicas de Abel Salazar, Universidade do
Porto, Portugal
| | - Sara Conde
- Pulmonology Department,
Centro
Hospitalar de Vila Nova de
Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Wolfram Windisch
- Faculty of Health/School of
Medicine, Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt
Köln gGmbH, Witten/Herdecke University, Cologne,
Germany
| | - Rui Nunes
- Faculty of Medicine,
University
of Porto, Porto, Portugal
| |
Collapse
|
10
|
Pierucci P, Portacci A, Carpagnano GE, Banfi P, Crimi C, Misseri G, Gregoretti C. The right interface for the right patient in noninvasive ventilation: a systematic review. Expert Rev Respir Med 2022; 16:931-944. [PMID: 36093799 DOI: 10.1080/17476348.2022.2121706] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Research in the field of noninvasive ventilation (NIV) has contributed to the development of new NIV interfaces. However, interface tolerance plays a crucial role in determining the beneficial effects of NIV therapy. AREAS COVERED This systematic review explores the most significant scientific research on NIV interfaces, with a focus on the potential impact that their design might have on treatment adherence and clinical outcomes. The rationale on the choice of the right interface among the wide variety of devices that are currently available is discussed here. EXPERT OPINION The paradigm "The right mask for the right patient" seems to be difficult to achieve in real life. Ranging from acute to chronic settings, the gold standard should include the tailoring of NIV interfaces to patients' needs and preferences. However, such customization may be hampered by issues of economic nature. High production costs and the increasing demand represent consistent burdens and have to be considered when dealing with patient-tailored NIV interfaces. New research focusing on developing advanced and tailored NIV masks should be prioritized; indeed, interfaces should be designed according to the specific patient and clinical setting where they need to be used.
Collapse
Affiliation(s)
- Paola Pierucci
- A. Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Dept. of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
| | - Andrea Portacci
- A. Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Dept. of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
| | - Giovanna Elisiana Carpagnano
- A. Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Dept. of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
| | - Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, Milano,Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, "Policlinico-Vittorio Emanuele San Marco" University Hospital, Catania, Italy
| | | | - Cesare Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Italy and Fondazione Istituto "G.Giglio" Cefalù', Palermo, Italy
| |
Collapse
|
11
|
Home-Based Respiratory Care for COPD Patients. SINUSITIS 2022. [DOI: 10.3390/sinusitis6020007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite significant advances in pharmacological treatment over the last few decades, COPD remains a heavy burden on the health systems around the world, affecting approximately 210 million people, with elevated morbimortality and socioeconomic impact. Barriers to healthcare access were even more evident during the coronavirus disease 19 (COVID-19) pandemic and increased patients’ vulnerability to physical deconditioning, depression, and social isolation. Home-based respiratory care in patients with COPD provides a valuable contribution to effective disease management, with potential advantages for monitoring, treatment adherence, and cost reduction. Technological innovation allows clinical markers of interest, such as respiratory frequency, pulmonary function, and oxygen saturation, to be tracked remotely from the patients’ homes, providing a better understanding of their real needs. Home-based telerehabilitation can also be a viable alternative to hospital-based programs. Here, we highlight the full extent of health benefits of HRC in COPD, particularly for patients with a higher risk of exacerbations, multiple comorbidities, and limited access to health services.
Collapse
|
12
|
Köhnlein T, Schwarz SB, Nagel S, Windisch W. Home Non-Invasive Positive Pressure Ventilation in Chronic Obstructive Pulmonary Disease: Why, Who, and How? Respiration 2022; 101:709-716. [PMID: 35717945 DOI: 10.1159/000525015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/25/2022] [Indexed: 11/19/2022] Open
Abstract
Advanced chronic obstructive pulmonary disease (COPD) might result in chronic hypercapnic ventilatory failure. Similar to neuromuscular and restrictive chest wall diseases, long-term non-invasive positive pressure ventilation (NPPV) is increasingly used in chronic hypercapnic COPD. This review describes the methods, patient selection, ventilatory strategies, and therapeutic effects of long-term Home-NPPV based on randomized controlled clinical trials published since 1985 in English language retrieved from the databases PubMed and Scopus. Long-term NPPV is feasible and effective in stable, non-exacerbated COPD patients with daytime hypercapnia with arterial pressure of carbon dioxide (PaCO2) levels ≥50 mm Hg (6.6 kPa), if the applied ventilatory pressures and application times improve baseline hypercapnia by at least 20%. Patients who survived an acute hypercapnic exacerbation might benefit from long-term NPPV if hypercapnia persists 2-4 weeks after resolution of the exacerbation. Pressure-controlled ventilation or pressure-support ventilation with adequate minimum backup breathing frequencies, in combination with nasal masks or oronasal masks have been successfully used in all larger clinical trials. Ventilatory strategies with mean inspiratory pressures of up to 28 cm H2O are well-tolerated by patients, but limitations exist in patients with impaired cardiac performance. Home-NPPV with a PaCO2-reductive approach might be considered as an additional treatment option in patients with stable chronic hypercapnic COPD.
Collapse
Affiliation(s)
- Thomas Köhnlein
- Facharztzentrum Teuchern und Mitteldeutsche Fachklinik für Schlafmedizin, Teuchern, Germany
| | - Sarah Bettina Schwarz
- Department of Pneumology, Kliniken der Stadt Köln GmbH, University of Witten/Herdecke, Cologne, Germany
| | - Stephan Nagel
- Klinikum St. Georg, Robert-Koch-Klinik, Respiratory Medicine, Leipzig, Germany
| | - Wolfram Windisch
- Department of Pneumology, Kliniken der Stadt Köln GmbH, University of Witten/Herdecke, Cologne, Germany
| |
Collapse
|
13
|
Paelet L, Raskin J, ZuWallack R. Potential downside issues with telemedicine for individuals with chronic respiratory diseases. Monaldi Arch Chest Dis 2022; 92. [DOI: 10.4081/monaldi.2022.2132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022] Open
Abstract
Telemedicine refers to the use of communications technologies to provide or enhance medical care through mitigating the negative effects of patient-caregiver distance on medical evaluation and treatment. The general concept, telemedicine, can refer to a number of interventions, such as telemonitoring, tele-consultations, tele-education, tele-communication, and tele-rehabilitation. While telemedicine has seen steady growth its trajectory has increased during the COVID-19 pandemic. As a tool in health care delivery, telemedicine is often met with patient satisfaction often resulting from ease of use and accessibility. Additionally, outcomes may improve, although the medical literature is not consistent in this regard. However, enthusiasm over its beneficial effects should be tempered by negative aspects, including the decrease in direct patient-clinician interaction (such as loss of information from the physical examination) and potentially serious privacy risks. Finding a happy median between positive and negative features of telemedicine remains a work in progress.
Collapse
|
14
|
Hatipoğlu U, Aboussouan LS. Chronic hypercapnic respiratory failure and non-invasive ventilation in people with chronic obstructive pulmonary disease. BMJ MEDICINE 2022; 1:e000146. [PMID: 36936555 PMCID: PMC9978688 DOI: 10.1136/bmjmed-2022-000146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/11/2022] [Indexed: 11/03/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) should no longer be seen as a condition for which little can be done. Novel pharmacotherapeutic interventions, surgical and procedural advances, and respiratory assist devices have provided numerous ways to help patients with COPD and treatable traits. For nearly 30 years, non-invasive ventilation, the application of positive pressure through a mask interface placed outside of the airway, has been the cornerstone for treatment of acute hypercapnic respiratory failure due to COPD exacerbation. Clinical trials indicate that this intervention could benefit patients with COPD and chronic hypercapnic respiratory failure in a stable state. This narrative review aims to provide the necessary background for internists to consider this therapeutic option for their COPD patients. We discuss the mechanism of action and implementation, and provide a glimpse into the future of this promising intervention.
Collapse
Affiliation(s)
- Umur Hatipoğlu
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | | |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Abstract
The clinical term dyspnea (a.k.a. breathlessness or shortness of breath) encompasses at least three qualitatively distinct sensations that warn of threats to breathing: air hunger, effort to breathe, and chest tightness. Air hunger is a primal homeostatic warning signal of insufficient alveolar ventilation that can produce fear and anxiety and severely impacts the lives of patients with cardiopulmonary, neuromuscular, psychological, and end-stage disease. The sense of effort to breathe informs of increased respiratory muscle activity and warns of potential impediments to breathing. Most frequently associated with bronchoconstriction, chest tightness may warn of airway inflammation and constriction through activation of airway sensory nerves. This chapter reviews human and functional brain imaging studies with comparison to pertinent neurorespiratory studies in animals to propose the interoceptive networks underlying each sensation. The neural origins of their distinct sensory and affective dimensions are discussed, and areas for future research are proposed. Despite dyspnea's clinical prevalence and impact, management of dyspnea languishes decades behind the treatment of pain. The neurophysiological bases of current therapeutic approaches are reviewed; however, a better understanding of the neural mechanisms of dyspnea may lead to development of novel therapies and improved patient care.
Collapse
Affiliation(s)
- Andrew P Binks
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States; Faculty of Health Sciences, Virginia Tech, Blacksburg, VA, United States.
| |
Collapse
|
17
|
Home mechanical ventilatio: the Dutch approach. Pulmonology 2021; 28:99-104. [PMID: 34903502 DOI: 10.1016/j.pulmoe.2021.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/23/2022] Open
Abstract
In the Netherlands we have an unique organisation of only 4 centres being responsible for all patients who need Home Mechanical ventilation(HMV). Nationwide criteria for referral and initiation of HMV are stated in our national guideline and recently a unique national learning management system (LMS) for all caregivers and professionals was developed. A nationwide multi-centric research program is running and every centre is participating. In this paper we provide information about the evolution of HMV in the Netherlands during the last 30 years, including details about the number of patients, different diagnose groups, residence and the type of ventilators.
Collapse
|
18
|
Steindal SA, Hofsø K, Aagaard H, Mariussen KL, Andresen B, Christensen VL, Heggdal K, Karlsen MMW, Kvande ME, Kynø NM, Langerud AK, Ohnstad MO, Sørensen K, Larsen MH. Non-invasive ventilation in the palliative care of patients with chronic obstructive pulmonary disease: a scoping review protocol. BMJ Open 2021; 11:e048344. [PMID: 34857555 PMCID: PMC8640644 DOI: 10.1136/bmjopen-2020-048344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Patients with advanced chronic obstructive pulmonary disease (COPD) experience a great symptom burden. Breathlessness is a very frequently reported symptom that negatively affects all aspects of daily life and could lead to fear of dying. Non-invasive ventilation (NIV) could be an important palliative measure to manage breathlessness in patients with advanced COPD. We decided to conduct a scoping review to attain an overview of the existing research and to identify knowledge gaps. This scoping review aims to systematically map published studies on the use of NIV in the palliative care of COPD patients, including the perspectives and experiences of patients, families and healthcare professionals. METHODS AND ANALYSIS This scoping review will employ the framework of Arksey and O'Malley. The reporting will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. A comprehensive and systematic search strategy will be developed in cooperation with an experienced librarian. Database searches will be conducted in AMED, PEDro, Embase, CINAHL, PsycInfo and MEDLINE in February 2021. Pairs of authors will independently assess studies' eligibility and extract data using a standardised data-charting form. The data will be inductively summarised and organised thematically. The results will be discussed with an advisory board consisting of nurses and physicians from respiratory and intensive care units. ETHICS AND DISSEMINATION Approval for the workshop with the advisory board has been attained from the Norwegian Centre for Research Data (480222), and approval will be attained from the Personal Data Protection Officers of the participating hospitals. All advisory board participants will sign an informed written consent before participation. The results could contribute to developing the body of evidence on the use of NIV in the palliative care of COPD patients and serve to identify directions for future research.
Collapse
Affiliation(s)
- Simen A Steindal
- Lovisenberg Diaconal University College, Oslo, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Kristin Hofsø
- Lovisenberg Diaconal University College, Oslo, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Hanne Aagaard
- Lovisenberg Diaconal University College, Oslo, Norway
| | | | - Brith Andresen
- Lovisenberg Diaconal University College, Oslo, Norway
- The Department of Cardiothoracic Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Vivi L Christensen
- Faculty of Health and Social Sciences, Department of Nursing and Health Sciences, University of South-Eastern Norway, Drammen, Norway
| | | | | | | | - Nina Margrethe Kynø
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Acute and Critical Illness, Oslo Metropolitan University, Oslo, Norway
| | | | | | - Kari Sørensen
- Lovisenberg Diaconal University College, Oslo, Norway
| | | |
Collapse
|
19
|
Using Telemedicine to Monitor the Patient with Chronic Respiratory Failure. Life (Basel) 2021; 11:life11111113. [PMID: 34832989 PMCID: PMC8620445 DOI: 10.3390/life11111113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/10/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Advances in management have improved mortality of individuals with chronic respiratory failure (CRF), leading to an increase in need for long-term oxygen therapy and/or ventilatory support. These individuals require frequent visits and monitoring of their physiological parameters as well as of the functioning of their devices, such as ventilators or oxygen concentrators. Telemedicine is a clinical application of Information Communication Technology connecting patients to specialised care consultants. This narrative review aims to explore the current available telemonitoring options for individuals with CRF and reported or potential results. Methods: The research focused on EMBASE, CINALH, PubMed, and Scopus databases. Papers published between 2003 and 2021 in English were considered. Results: Different sensors, transmission devices and systems, and interventions are used with promising but not conclusive clinical results. However, legal problems are still unsolved, and economic advantages for health care systems, although potentially high, are still under debate. Conclusions: Telemonitoring systems for individuals with CRF are increasingly used; with promising results still to be clarified, legal, economical and organisational issues must be defined.
Collapse
|
20
|
Raveling T, Vonk J, Struik FM, Goldstein R, Kerstjens HA, Wijkstra PJ, Duiverman ML. Chronic non-invasive ventilation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2021; 8:CD002878. [PMID: 34368950 PMCID: PMC8407093 DOI: 10.1002/14651858.cd002878.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Chronic non-invasive ventilation (NIV) is increasingly being used to treat people with COPD who have respiratory failure, but the evidence supporting this treatment has been conflicting. OBJECTIVES To assess the effects of chronic non-invasive ventilation at home via a facial mask in people with COPD, using a pooled analysis of IPD and meta-analysis. SEARCH METHODS We searched the Cochrane Airways Register of Trials, MEDLINE, Embase, PsycINFO, CINAHL, AMED, proceedings of respiratory conferences, clinical trial registries and bibliographies of relevant studies. We conducted the latest search on 21 December 2020. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing chronic NIV for at least five hours per night for three consecutive weeks or more (in addition to standard care) versus standard care alone, in people with COPD. Studies investigating people initiated on NIV in a stable phase and studies investigating NIV commenced after a severe COPD exacerbation were eligible, but we reported and analysed them separately. The primary outcomes were arterial blood gases, health-related quality of life (HRQL), exercise capacity (stable COPD) and admission-free survival (post-exacerbation COPD). Secondary outcomes for both populations were: lung function, COPD exacerbations and admissions, and all-cause mortality. For stable COPD, we also reported respiratory muscle strength, dyspnoea and sleep efficiency. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. After inclusion of a study, we requested the IPD. We analysed continuous and time-to-event data using linear- and cox-regression mixed-effect models with a random effect on study level. We analysed dichotomous IPD using generalised estimating equations. We adjusted all models for age and sex. We assessed changes in outcomes after three and 12 months. We also conducted a meta-analysis on aggregated trial data. MAIN RESULTS We included 14 new RCTs in this review update, in addition to the seven previously included. Seventeen studies investigated chronic NIV in stable COPD and four studies investigated chronic NIV commenced after a severe COPD exacerbation. Three studies compared NIV to sham continuous positive airway pressure (2 to 4 cmH2O). Seven studies used a nasal mask, one study used an oronasal mask and eight studies used both interfaces. Five studies did not report the interface. The majority of trials (20/21) were at high risk of performance bias due to an unblinded design. We considered 11 studies to have a low risk of selection bias and 13 to have a low risk of attrition bias. We collected and analysed the IPD from 13 stable COPD studies (n = 778, 68% of the participants included) and from three post-exacerbation studies (n = 364, 96% of the participants included). In the stable COPD group, NIV probably results in a minor benefit on the arterial partial pressure of oxygen (PaO2) after three months (adjusted mean difference (AMD) 0.27 kPa, 95% CI 0.04 to 0.49; 9 studies, 271 participants; moderate-certainty evidence), but there was little to no benefit at 12 months (AMD 0.09 kPa, 95% CI -0.23 to 0.42; 3 studies, 171 participants; low-certainty evidence). The arterial partial pressure of carbon dioxide (PaCO2) was reduced in participants allocated to NIV after three months (AMD -0.61 kPa, 95% CI -0.77 to -0.45; 11 studies, 475 participants; high-certainty evidence) and persisted up to 12 months (AMD -0.42 kPa, 95% CI -0.68 to -0.16; 4 studies, 232 participants; high-certainty evidence). Exercise capacity was measured with the 6-minute walking distance (minimal clinical important difference: 26 m). There was no clinically relevant effect of NIV on exercise capacity (3 months: AMD 15.5 m, 95% CI -0.8 to 31.7; 8 studies, 330 participants; low-certainty evidence; 12 months: AMD 26.4 m, 95% CI -7.6 to 60.5; 3 studies, 134 participants; very low-certainty evidence). HRQL was measured with the Severe Respiratory Insufficiency and the St. Georges's Respiratory Questionnaire and may be improved by NIV, but only after three months (3 months: standardised mean difference (SMD) 0.39, 95% CI 0.15 to 0.62; 5 studies, 259 participants; very low-certainty evidence; 12 months: SMD 0.15, 95% CI -0.13 to 0.43; 4 studies, 200 participants; very low-certainty evidence). Lastly, the risk for all-cause mortality is likely reduced by NIV (adjusted hazard ratio (AHR) 0.75, 95% CI 0.58 to 0.97; 3 studies, 405 participants; moderate-certainty evidence). In the post-exacerbation COPD group, there was little to no benefit on the PaO2 after three months, but there may be a slight decrease after 12 months (3 months: AMD -0.10 kPa, 95% CI -0.65 to 0.45; 3 studies, 234 participants; low-certainty evidence; 12 months: -0.27 kPa, 95% CI -0.86 to 0.32, 3 studies; 170 participants; low-certainty evidence). The PaCO2 was reduced by NIV at both three months (AMD -0.40 kPa, 95% CI -0.70 to -0.09; 3 studies, 241 participants; moderate-certainty evidence) and 12 months (AMD -0.52 kPa, 95% CI -0.87 to -0.18; 3 studies, 175 participants; high-certainty evidence). NIV may have little to no benefit on HRQL (3 months: SMD 0.25, 95% CI -0.01 to 0.51; 2 studies, 219 participants; very low-certainty evidence; 12 months: SMD 0.25, 95% -0.06 to 0.55; 2 studies, 164 participants; very low-certainty evidence). Admission-free survival seems improved with NIV (AHR 0.71, 95% CI 0.54 to 0.94; 2 studies, 317 participants; low-certainty evidence), but the risk for all-cause mortality does not seem to improve (AHR 0.97, 95% CI 0.74 to 1.28; 2 studies, 317 participants; low-certainty evidence). AUTHORS' CONCLUSIONS Regardless of the timing of initiation, chronic NIV improves daytime hypercapnia. In addition, in stable COPD, survival seems to be improved and there might be a short term HRQL benefit. In people with persistent hypercapnia after a COPD exacerbation, chronic NIV might prolong admission-free survival without a beneficial effect on HRQL. In stable COPD, future RCTs comparing NIV to a control group receiving standard care might no longer be warranted, but research should focus on identifying participant characteristics that would define treatment success. Furthermore, the optimal timing for initiation of NIV after a severe COPD exacerbation is still unknown.
Collapse
Affiliation(s)
- Tim Raveling
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, Netherlands
| | - Judith Vonk
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Fransien M Struik
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Roger Goldstein
- Division of Respiratory Medicine, West Park Healthcare Centre, University of Toronto, Toronto, Canada
| | - Huib Am Kerstjens
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, Netherlands
| | - Peter J Wijkstra
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, Netherlands
| | - Marieke L Duiverman
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, Netherlands
| |
Collapse
|
21
|
Ribeiro C, Vieira AL, Pamplona P, Drummond M, Seabra B, Ferreira D, Liberato H, Carreiro A, Vicente I, Castro L, Costa P, Carriço F, Martin T, Cravo J, Teixeira N, Grafino M, Conde S, Windisch W, Nunes R. Current Practices in Home Mechanical Ventilation for Chronic Obstructive Pulmonary Disease: A Real-Life Cross-Sectional Multicentric Study. Int J Chron Obstruct Pulmon Dis 2021; 16:2217-2226. [PMID: 34349507 PMCID: PMC8328383 DOI: 10.2147/copd.s314826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/19/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Home mechanical ventilation (HMV) use in chronic obstructive pulmonary disease (COPD) is becoming increasingly widespread. The aim of this study was to provide an accurate description of the current practices and clinical characteristics of COPD patients on HMV in Portugal. Methods The study was designed as a cross-sectional, multicenter real-life study of COPD patients established on HMV for at least 30 days. Data related to clinical characteristics, adaptation and ventilatory settings were collected. Results The study included 569 COPD patients on HMV from 15 centers. The majority were male, with a median age of 72 years and a high prevalence of obesity (43.2%) and sleep apnea (45.8%). A high treatment compliance was observed (median 8h/day), 48.7% with inspiratory positive airway pressure ≥20 cmH2O and oronasal masks were the preferred interface (91.7%). There was an equal distribution of patients starting HMV during chronic stable condition and following an exacerbation. Patients in stable condition were initiated in the outpatient setting in 92.3%. Despite the differences in criteria and setting of adaptation and a slightly lower BMI in patients starting HMV following an exacerbation, we found no significant differences regarding age, gender, ventilation pressures, time on HMV, usage, severity of airflow obstruction or current arterial blood gas analysis (ABGs) in relation to patients adapted in stable condition. Conclusion Patients were highly compliant with the therapy. In agreement with most recent studies and recommendations, there seems to be a move towards higher ventilation pressures, increased use of oronasal masks and an intent to obtain normocapnia. This study shows that chronic hypercapnic and post exacerbation patients do not differ significantly regarding patient characteristics, physiological parameters or ventilatory settings with one exception: chronic hypercapnic patients are more often obese and, subsequently, more frequently present OSA.
Collapse
Affiliation(s)
- Carla Ribeiro
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - Paula Pamplona
- Pulmonology Department, Centro Hospitalar Universitário Lisboa Norte - Hospital Pulido Valente, Lisboa, Portugal
| | - Marta Drummond
- Centro de Responsabilidade Integrado Sono e VNI do Centro Hospitalar e Universitário São João, Porto, Portugal.,Faculty of Medicine, Porto University, Porto, Portugal
| | - Bárbara Seabra
- Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Diva Ferreira
- Pulmonology Department, Centro Hospitalar do Médio Ave, Famalicão, Portugal
| | - Hedi Liberato
- Pulmonology Department, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Alexandra Carreiro
- Pulmonology Department, Hospital do Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Portugal
| | - Inês Vicente
- Pulmonology Department, Centro Hospitalar Universitário da Cova da Beira, Covilhã, Portugal
| | - Luísa Castro
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal.,School of Health of Polytechnic of Porto, Porto, Portugal
| | - Pedro Costa
- Pulmonology Functional Unit, Unidade Local de Saúde do Norte Alentejano, Portalegre, Portugal
| | - Filipa Carriço
- Pulmonology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - Teresa Martin
- Pulmonology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - João Cravo
- Pulmonology Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Nélson Teixeira
- Pulmonology Department, Unidade Local de Saúde do Nordeste, Bragança, Portugal
| | - Mónica Grafino
- Pulmonology Department, Hospital da Luz, Lisboa, Portugal
| | - Sara Conde
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University, Cologne, Germany
| | - Rui Nunes
- Faculty of Medicine, Porto University, Porto, Portugal
| |
Collapse
|
22
|
Donner CF, ZuWallack R, Nici L. The Role of Telemedicine in Extending and Enhancing Medical Management of the Patient with Chronic Obstructive Pulmonary Disease. ACTA ACUST UNITED AC 2021; 57:medicina57070726. [PMID: 34357007 PMCID: PMC8307990 DOI: 10.3390/medicina57070726] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 01/05/2023]
Abstract
Medical management of a chronic obstructive pulmonary disease (COPD) patient must incorporate a broadened and holistic approach to achieve optimal outcomes. This is best achieved with integrated care, which is based on the chronic care model of disease management, proactively addressing the patient’s unique medical, social, psychological, and cognitive needs along the trajectory of the disease. While conceptually appealing, integrated care requires not only a different approach to disease management, but considerably more health care resources. One potential way to reduce this burden of care is telemedicine: technology that allows for the bidirectional transfer of important clinical information between the patient and health care providers across distances. This not only makes medical services more accessible; it may also enhance the efficiency of delivery and quality of care. Telemedicine includes distinct, often overlapping interventions, including telecommunication (enhancing lines of communication), telemonitoring (symptom reporting or the transfer of physiological data to health care providers), physical activity monitoring and feedback to the patient and provider, remote decision support systems (identifying “red flags,” such as the onset of an exacerbation), tele-consultation (directing assessment and care from a distance), tele-education (through web-based educational or self-management platforms), tele-coaching, and tele-rehabilitation (providing educational material, exercise training, or even total pulmonary rehabilitation at a distance when standard, center-based rehabilitation is not feasible). While the above components of telemedicine are conceptually appealing, many have had inconsistent results in scientific trials. Interventions with more consistently favorable results include those potentially modifying physical activity, non-invasive ventilator management, and tele-rehabilitation. More inconsistent results in other telemedicine interventions do not necessarily mean they are ineffective; rather, more data on refining the techniques may be necessary. Until more outcome data are available clinicians should resist being caught up in novel technologies simply because they are new.
Collapse
Affiliation(s)
- Claudio F. Donner
- Fondazione Mondo Respiro ONLUS, Via Monsignor Cavigioli, 10, 28021 Borgomanero, Italy
- Correspondence:
| | - Richard ZuWallack
- Pulmonary and Critical Care, St Francis Hospital and Medical Center, Hartford, CT 06015, USA;
- University of CT, Farmington, CT 06030, USA
| | - Linda Nici
- Pulmonary and Critical Care Section, Providence Veterans Administration Medical Center, Brown University, Providence, RI 02908, USA;
| |
Collapse
|
23
|
Antón A, Díaz Lobato S, Guimarães MJ, Alonso-Álvarez ML, Correia S, Gonçalves MR. Home Mechanical Ventilation Practices in Spain and Portugal. OPEN RESPIRATORY ARCHIVES 2021. [PMID: 37496771 PMCID: PMC10369612 DOI: 10.1016/j.opresp.2021.100116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction Home mechanical ventilation (HMV) practice has changed with publication of new evidence and introduction of new technologies, and varies between countries. This study investigated current HMV use and practices in Spain and Portugal. Methods 94 healthcare professionals identified as regularly performing HMV-related activities were sent an e-mail link to an online questionnaire. The questionnaire included 40 items relating to responder demographics, non-invasive ventilation (NIV) care structure, ventilated patient profile, work habits, and potential future practice improvements. Results 66 questionnaires (70%) were returned (Spain, 36; Portugal, 30). The majority of respondents were physicians (Spain, 95%; Portugal, 63%). Overall, 83% of hospitals had a dedicated NIV unit (Spain, 100%; Portugal, 63%). The most common indication for HMV was neuromuscular disorders in Spain and obstructive diseases in Portugal. Homecare providers (HCPs) and pulmonologists were usually responsible for managing HMV; HCPs were involved more often in Portugal. Choice of ventilator was most often based on usage hours/day; the most important device features were 'ease of use' (Spain) and 'adjustment range' (Portugal). HMV monitoring practices varied between countries. Telemonitoring was used more often in Portugal (20%; vs. Spain, 3%). Follow-up frequency and practices also differed markedly between Spain and Portugal. Respondents highlighted identification of new patient groups and patient phenotyping to optimize treatment and personalize therapy as future HMV strategies. Conclusions Important differences in the management of HMV were observed between two similar European countries. Better understanding of clinical practices can facilitate targeted education and training to ensure optimal management of patients using HMV.
Collapse
|
24
|
Sørensen SS, Storgaard LH, Weinreich UM. Cost-Effectiveness of Domiciliary High Flow Nasal Cannula Treatment in COPD Patients with Chronic Respiratory Failure. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:553-564. [PMID: 34168472 PMCID: PMC8219115 DOI: 10.2147/ceor.s312523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/13/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the cost-effectiveness of long-term domiciliary high flow nasal cannula (HFNC) treatment in COPD patients with chronic respiratory failure. PATIENTS AND METHODS A cohort of 200 COPD patients were equally randomized into usual care ± HFNC and followed for 12 months. The outcome of the analysis was the incremental cost per quality-adjusted life-year (QALY) gained, and the analysis was conducted from a healthcare sector perspective. Data on the patients' health-related quality of life (HRQoL), gathered throughout the trial using the St. George's Respiratory Questionnaire (SGRQ), was converted into EQ-5D-3L health state utility values. Costs were estimated using Danish registers and valued in British pounds (£) at price level 2019. Scenario analyses and probabilistic sensitivity analyses were conducted to assess the uncertainty of the results. RESULTS The adjusted mean difference in QALYs between the HFNC group and the control group was 0.059 (95% CI: 0.017; 0.101), and the adjusted mean difference in total costs was £212 (95% CI: -1572; 1995). The analysis resulted in an incremental cost-effectiveness ratio (ICER) of £3605 per QALY gained. At threshold values of £20.000-30.000 per QALY gained, the intervention had an 83-92% probability of being cost-effective. The scenario analyses all revealed ICERs below the set threshold value and demonstrated the robustness of the main result. CONCLUSION This is the first cost-effectiveness study on domiciliary HFNC in Europe. The findings demonstrate that long-term domiciliary HFNC treatment is very likely to be a cost-effective addition to usual care for COPD patients with chronic respiratory failure. The results must be interpreted in light of the uncertainty associated with the indirect estimation of health state utilities.
Collapse
Affiliation(s)
- Sabrina Storgaard Sørensen
- Danish Center for Health Care Improvements, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Line Hust Storgaard
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
25
|
Shah NM, Kaltsakas G. Telemedicine in the management of patients with chronic respiratory failure. Breathe (Sheff) 2021; 17:210008. [PMID: 34295411 PMCID: PMC8291909 DOI: 10.1183/20734735.0008-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/12/2021] [Indexed: 12/20/2022] Open
Abstract
Patients with chronic respiratory failure are often required to attend multiple hospital appointments, which may be difficult due to their physical disabilities and the amount of equipment they are required to bring. Their caregivers often struggle with the lack of immediate care available when the patient suffers difficulties at home. Telemedicine is an opportunity to bridge the gap between home and healthcare professionals by allowing the healthcare team to reach into patients' homes to provide more frequent support. The evidence for the use of telemedicine in patients with chronic respiratory failure remains equivocal. Although the uptake of telemedicine has been slow, the SARS-CoV-2 pandemic has resulted in the rapid dissemination of telemedicine to allow the delivery of care to vulnerable patients while reducing the need for their attendance in hospital. Logistical and legal challenges to the delivery of telemedicine remain, but the pandemic may serve as a driver to ameliorate these challenges and facilitate wider use of this technology to improve the experience of patients with chronic respiratory failure. Educational aims To provide an overview of the rationale for delivering care via telemedicine for patients with chronic respiratory failure.To provide the evidence base for establishing a telemedicine service.To highlight the potential opportunities and challenges in delivering a telemedicine service for patients with chronic respiratory failure.
Collapse
Affiliation(s)
- Neeraj M Shah
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Georgios Kaltsakas
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| |
Collapse
|
26
|
Pierucci P, Crimi C, Carlucci A, Carpagnano GE, Janssens JP, Lujan M, Noto A, Wijkstra PJ, Windisch W, Scala R. REINVENT: ERS International survey on REstrictive thoracic diseases IN long term home noninvasive VENTilation. ERJ Open Res 2021; 7:00911-2020. [PMID: 33898619 PMCID: PMC8053911 DOI: 10.1183/23120541.00911-2020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background and aim Little is known about the current use of long-term home noninvasive ventilation (LTHNIV) in restrictive thoracic diseases, including chest wall disorders and neuromuscular disorders (NMD). This study aimed to capture the pattern of LTHNIV in patients with restrictive thoracic diseases via a web-based international survey. Methods The survey involved European Respiratory Society (ERS) Assembly 2.02 (NIV-dedicated group), from October to December 2019. Results 166 (22.2%) out of 748 members from 41 countries responded; 80% were physicians, of whom 43% worked in a respiratory intermediate intensive care unit. The ratio of NMD to chest wall disorders was 5:1, with amyotrophic lateral sclerosis the most frequent indication within NMD (78%). The main reason to initiate LTHNIV was diurnal hypercapnia (71%). Quality of life/sleep was the most important goal to achieve. In 25% of cases, clinicians based their choice of the ventilator on patients' feedback. Among NIV modes, spontaneous-timed pressure support ventilation (ST-PSV) was the most frequently prescribed for day- and night-time. Mouthpieces were the preferred daytime NIV interface, whereas oro-nasal masks the first choice overnight. Heated humidification was frequently added to LTHNIV (72%). Single-limb circuits with intentional leaks (79%) were the most frequently prescribed. Follow-up was most often provided in an outpatient setting. Conclusions This ERS survey illustrates physicians' practices of LTHNIV in patients with restrictive thoracic diseases. NMD and, specifically, amyotrophic lateral sclerosis were the main indications for LTHNIV. NIV was started mostly because of diurnal hypoventilation with a primary goal of patient-centred benefits. Bi-level ST-PSV and oro-nasal masks were more likely to be chosen for providing NIV. LTHNIV efficacy was assessed mainly in an outpatient setting.
Collapse
Affiliation(s)
- Paola Pierucci
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy.,"Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, "Policlinico-Vittorio Emanuele San Marco" University Hospital, Catania, Italy
| | - Annalisa Carlucci
- Reparto Pneumologia Riabilitativa Istituti Clinici Scientifici Maugeri Pavia, Pavia, Italy.,Dipartimento di Medicina e Chirurgia, Università Insubria Varese-Como, Varese, Italy
| | - Giovanna E Carpagnano
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy.,"Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Manel Lujan
- Pneumology Service, Hospital Universitari Parc Taulí de Sabadell, Universitat Autònoma de Barcelona, CIBERES, Sabadell, Spain
| | - Alberto Noto
- Dept of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Division of Anesthesia and Intensive Care, University of Messina, Policlinico "G. Martino", Messina, Italy.,IPCF-CNR, Institute for Chemical and Physical Processes, National Research Council, Messina, Italy
| | - Peter J Wijkstra
- 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
| | - Wolfram Windisch
- Cologne Merheim Hospital, Dept of Pneumology, Kliniken der Stadt Köln; gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S Donato Hospital, Arezzo, Italy
| |
Collapse
|
27
|
Mendonça Almeida L, Jacob M, Van Zeller M, Pinto T, Gonçalves M, Drummond M. Non-invasive ventilation in the elderly - never too late! Monaldi Arch Chest Dis 2021; 91. [PMID: 33794594 DOI: 10.4081/monaldi.2021.1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/24/2021] [Indexed: 11/23/2022] Open
Abstract
Dear Editor, Practising evidence-based medicine in an ageing population is challenging. Nevertheless, using age as a diagnostic or therapeutic procedure contraindication is less and less common. Domiciliary non-invasive ventilation (NIV) in chronic respiratory failure patients has been largely used; however, data from older people is scarce...
Collapse
Affiliation(s)
| | - Maria Jacob
- Pulmonology Department, Centro Hospitalar Universitário São João.
| | - Mafalda Van Zeller
- Sleep and Non-invasive Ventilation Unit, Centro Hospitalar Universitário São João.
| | - Tiago Pinto
- Sleep and Non-invasive Ventilation Unit, Centro Hospitalar Universitário São João.
| | - Miguel Gonçalves
- Pulmonology Department, Centro Hospitalar Universitário São João.
| | - Marta Drummond
- Sleep and Non-invasive Ventilation Unit, Centro Hospitalar Universitário São João.
| |
Collapse
|
28
|
Theunisse C, Ponssen HH, de Graaf NTC, Scholten-Bakker M, Willemsen SP, Cheung D. The Effects of Low Pressure Domiciliary Non-Invasive Ventilation on Clinical Outcomes in Patients with Severe COPD Regardless Having Hypercapnia. Int J Chron Obstruct Pulmon Dis 2021; 16:817-824. [PMID: 33814905 PMCID: PMC8009340 DOI: 10.2147/copd.s289099] [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: 11/09/2020] [Accepted: 02/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background The effectiveness of non-invasive home ventilation in patients with severe chronic obstructive pulmonary disease (COPD) is lacking. Non-invasive home ventilation might be more effective when high ventilator settings are used. However, high ventilator settings might reduce patient adherence. We have developed a multidisciplinary approach (ventilation practitioners, 24 hours support of respiratory nurses, physicians) to non-invasive ventilation aimed at optimizing patient adherence using low ventilator settings in severe COPD patients with high disease burden irrespectively having hypercapnia. Methods We included in a proof of concept, prospective interventional study, 48 GOLD stage III-IV COPD patients with a high disease burden (≥2 exacerbations in a year, and Medical Research Council dyspnea scores ≥3). Outcome measures included hospital admissions, capillary pCO2, Medical Research Council dyspnea scores (MRC), Clinical COPD Questionnaire scores (CCQ) and Hospital Anxiety and Depression Scale (HADS). Results After 1 year 32 patients could be evaluated. Hospital admissions decreased by 1.0 admission (mean difference ± SD: 1.0 ± 1.48; p = 0.001). In-hospital days decreased by 10.0 days (10.0 ± 15.48; p = 0.001). Capillary pCO2 decreased by 0.33 kPa (0.33 ± 0.81: p = 0.03). The MRC dyspnea score decreased by 0.66 (0.66 ± 1.35; p = 0.02). The CCQ score decreased by 0.59 (0.59 ± 1.39; p = 0.03). The HADS anxiety score decreased by 1.64 (1.64 ± 3.12; p = 0.01). The HADS depression score decreased by 1.64 (1.64 ± 3.91; p = 0.04). Conclusion A proof of concept multidisciplinary approach, using low pressure domiciliary non-invasive ventilation, aimed at optimizing patient adherence in severe COPD patients regardless having hypercapnia, reduced hospital admissions and improved symptoms and quality of life measures. This may imply that severe COPD patients with high disease burden, irrespective being hypercapnic, are candidates to be treated with low pressure domiciliary non-invasive ventilation.
Collapse
Affiliation(s)
- Christiaan Theunisse
- Department of Pulmonology, Albert Schweitzer Hospital, Dordrecht, the Netherlands.,Department of Intensive Care, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Huibert H Ponssen
- Department of Intensive Care, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Netty T C de Graaf
- Department of Pulmonology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | | | - Sten P Willemsen
- Department of Biostatics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - David Cheung
- Department of Pulmonology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| |
Collapse
|
29
|
Majorski DS, Callegari JC, Schwarz SB, Magnet FS, Majorski R, Storre JH, Schmoor C, Windisch W. Oronasal versus Nasal Masks for Non-Invasive Ventilation in COPD: A Randomized Crossover Trial. Int J Chron Obstruct Pulmon Dis 2021; 16:771-781. [PMID: 33814901 PMCID: PMC8009345 DOI: 10.2147/copd.s289755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/11/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The impact of oronasal and nasal masks on the quality of nocturnal non-invasive ventilation (NIV) needs to be clarified. This trial was designed to compare the impact of oronasal and nasal masks on the objective quality and subjective acceptance of nocturnal NIV in COPD-patients. Patients and Methods In a randomized crossover trial, 30 COPD-patients with well-established high-intensity NIV (mean inspiratory/expiratory positive airway pressure 26±3/5±1 cmH2O, mean respiratory back-up rate 17±1/min) were ventilated for two consecutive nights on oronasal and nasal masks, respectively. Results Full polysomnography, nocturnal blood gas measurements, and subjective assessments were performed. There was a tendency towards improved sleep efficiency (primary outcome) when an oronasal mask was worn (+9.9%; 95% CI:-0.2%-20.0%; P=0.054). Sleep stages 3/4 were favored by the oronasal mask (+12.7%; 95% CI: 6.0%-19.3%; P=<0.001). Subjective assessments were comparable with the exception of items related to leakage (P<0.05 in favor of nasal masks). The mean transcutaneous PCO2 value for oronasal masks (47.7±7.4 mmHg) was comparable to that of nasal masks (48.9±6.6 mmHg) (P=0.11). There was considerable diversity amongst individual patients in terms of sleep quality and gas exchange following mask exchange. Subjective mask preference was not associated with sleep quality, but with nocturnal dyspnea. Over 40% of patients subsequently switched to the mask that they were not previously accustomed to. Conclusion In general, oronasal and nasal masks are each similarly capable of successfully delivering NIV in COPD-patients. However, the individual response to different interfaces is extremely heterogeneous, while subjective mask preference is independent from objective measures, but associated with dyspnea. Trial Registration German Clinical Trials Registry (DRKS00007741).
Collapse
Affiliation(s)
- Daniel S Majorski
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Jens C Callegari
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Sarah B Schwarz
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Friederike S Magnet
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Rodion Majorski
- Department of Neurology and Neurophysiology, Helios Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - Jan H Storre
- Praxis Pneumologie Solln, Munich, Germany.,Department of Pneumology, University Medical Hospital, Freiburg, Germany
| | - Claudia Schmoor
- Clinical Trials Unit, Medical Center - University Medical Hospital, Freiburg, Germany
| | - Wolfram Windisch
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| |
Collapse
|
30
|
Mycroft K, Nasiłowski J, Klimiuk J, Przybyłowski T. Complex home assessment of long-term non-invasive ventilation efficacy using transcutaneous monitoring of PCO 2 and polygraphy - A feasibility study. Adv Med Sci 2021; 66:105-112. [PMID: 33461098 DOI: 10.1016/j.advms.2021.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/21/2020] [Accepted: 01/04/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Home non-invasive ventilation (HNIV) during sleep is a standard treatment for chronic hypercapnic respiratory failure (CHRF). The aim of this study was to evaluate the feasibility of the complex overnight assessment of HNIV in adults performed at home and the efficacy of HNIV after one year of treatment. METHODS Stable patients with CHRF on HNIV for more than 12 months had unattended polygraphy (PG) with transcutaneous monitoring of PCO2 (tcPCO2) at home during one night. The recording quality was regarded as excellent when 100% and good if 80-99% of the analysis time was registered. The following efficacy criteria were approved: (1) SpO2<90% for <10% of analysis time, (2) increase in PtcCO2 ≤7.5 mmHg between baseline and average value at night, (3) apnea-hypopnea index (AHI) ≤5/h. RESULTS Eighteen patients with CHRF (median age 66 [60-74] years, 10 female) were included. The quality of the PG tracings was good to excellent in 16 (89%) patients and the quality of the tcPCO2 data was good to excellent in 14 (78%) patients. There was no difference in the quality of tcPCO2 between patients who lived alone and those who lived with family (100 [50-100]% vs. 100 [90-100]% of analysis time, respectively). Only 4 (22%) patients fulfilled all three efficacy criteria. CONCLUSIONS Home-based monitoring using PG and tcPCO2 is a feasible and adequate tool to assess the efficacy of HNIV. In most of the patients on HNIV for more than 12 months, the treatment was not effective based on the predefined efficacy criteria.
Collapse
Affiliation(s)
- Katarzyna Mycroft
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland.
| | - Jacek Nasiłowski
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Klimiuk
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Tadeusz Przybyłowski
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
31
|
Janssens JP, Michel F, Schwarz EI, Prella M, Bloch K, Adler D, Brill AK, Geenens A, Karrer W, Ogna A, Ott S, Rüdiger J, Schoch OD, Soler M, Strobel W, Uldry C, Gex G. Long-Term Mechanical Ventilation: Recommendations of the Swiss Society of Pulmonology. Respiration 2020; 99:1-36. [PMID: 33302274 DOI: 10.1159/000510086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022] Open
Abstract
Long-term mechanical ventilation is a well-established treatment for chronic hypercapnic respiratory failure (CHRF). It is aimed at improving CHRF-related symptoms, health-related quality of life, survival, and decreasing hospital admissions. In Switzerland, long-term mechanical ventilation has been increasingly used since the 1980s in hospital and home care settings. Over the years, its application has considerably expanded with accumulating evidence of beneficial effects in a broad range of conditions associated with CHRF. Most frequent indications for long-term mechanical ventilation are chronic obstructive pulmonary disease, obesity hypoventilation syndrome, neuromuscular and chest wall diseases. In the current consensus document, the Special Interest Group of the Swiss Society of Pulmonology reviews the most recent scientific literature on long-term mechanical ventilation and provides recommendations adapted to the particular setting of the Swiss healthcare system with a focus on the practice of non-invasive and invasive home ventilation in adults.
Collapse
Affiliation(s)
- Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland,
| | - Franz Michel
- Klinik für Neurorehabilitation und Paraplegiologie, Basel, Switzerland
| | - Esther Irene Schwarz
- Department of Pulmonology and Sleep Disorders Centre, University Hospital of Zurich, Zurich, Switzerland
| | - Maura Prella
- Division of Pulmonary Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Konrad Bloch
- Department of Pulmonology and Sleep Disorders Centre, University Hospital of Zurich, Zurich, Switzerland
| | - Dan Adler
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | | | - Aurore Geenens
- Pulmonary League of the Canton of Vaud, Lausanne, Switzerland
| | | | - Adam Ogna
- Respiratory Medicine Service, Locarno Regional Hospital, Locarno, Switzerland
| | - Sebastien Ott
- Universitätsklinik für Pneumologie, Universitätsspital (Inselspital) und Universität, Bern, Switzerland
- Division of Pulmonary Diseases, St. Claraspital, Basel, Switzerland
| | - Jochen Rüdiger
- Division of Pulmonary and Sleep Medicine, Medizin Stollturm, Münchenstein, Switzerland
| | - Otto D Schoch
- Division of Pulmonary Diseases, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Markus Soler
- Division of Pulmonary Diseases, St. Claraspital, Basel, Switzerland
| | - Werner Strobel
- Division of Pulmonary Diseases, Universitätsspital Basel, Basel, Switzerland
| | - Christophe Uldry
- Division of Pulmonary Diseases and Pulmonary Rehabilitation Center, Rolle Hospital, Rolle, Switzerland
| | - Grégoire Gex
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Pulmonary Diseases, Hôpital du Valais, Sion, Switzerland
| |
Collapse
|
32
|
Klingshirn H, Gerken L, Heuschmann P, Haas K, Schutzmeier M, Brandstetter L, Stangl S, Wurmb T, Kippnich M, Reuschenbach B. [Quality of Care for People with Home Mechanical Ventilation in Germany: A Scoping Review]. DAS GESUNDHEITSWESEN 2020; 82:729-739. [PMID: 32650350 PMCID: PMC7518336 DOI: 10.1055/a-1164-6516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hintergrund
Die außerklinische Intensivversorgung von Menschen
mit Langzeitbeatmung ist ein stark anwachsender Bereich mit vielseitigen
Versorgungsbedarfen. Ziel dieses Scoping Reviews ist es, den aktuellen
Forschungsstand zur Qualität der Versorgung beatmeter Menschen in der
außerstationären Intensivpflege in Deutschland darzustellen und
Forschungslücken aufzudecken.
Methode
Anhand definierter Einschlusskriterien wurden 4 Datenbanken nach
Publikationen zur Versorgung von außerklinisch beatmeten Menschen in
Deutschland durchsucht. Datenextraktion und Synthese erfolgten nach der Methode
der „data driven thematic analysis“. Eine Differenzierung
zwischen Forschung und Expertenmeinung fand statt.
Ergebnisse
Die Suche ergab 493 Treffer, von denen insgesamt 68
Publikationen eingeschlossen wurden, darunter 2 Leitlinien (3%), 45
(66%) Forschungsarbeiten und 21 (31%) Expertenmeinungen.
Inhaltlich konnten folgende Themenfelder identifiziert werden: Organisation und
Steuerung der Beatmung (n=43; 63%), pflegerische (n=23;
34%), medizinische (n=39; 57%), therapeutische
(n=7; 10%) und Hilfsmittelversorgung (n=24;
35%), sowie die Sicht beatmeter Personen und deren Angehörigen
(n=33; 49%) und weitere Themen (n=13; 19%).
Schlussfolgerung
Obwohl der Qualitätsdiskurs zur Versorgung
beatmeter Personen in der außerklinischen Intensivpflege breit
geführt wird, fehlen Studien zur Bedarfsgerechtigkeit von
Versorgungsleistungen, zu Selbstbestimmung und Teilhabe in Abhängigkeit
der Wohnform oder zur Rolle einzelner ‚Health Professionals‘ im
interprofessionellen Team.
Collapse
Affiliation(s)
| | - Laura Gerken
- Katholische Stiftungshochschule München, München
| | - Peter Heuschmann
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg.,Zentrale für Klinische Studien Würzburg, Universitätsklinikum Würzburg, Würzburg.,Deutsches Zentrum für Herzinsuffizienz (DZHI), Universität Würzburg, Würzburg
| | - Kirsten Haas
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg
| | - Martha Schutzmeier
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg
| | - Lilly Brandstetter
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg
| | - Stephanie Stangl
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg
| | - Thomas Wurmb
- Sektion Notfall- und Katastrophenmedizin, Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Würzburg
| | - Maximilian Kippnich
- Sektion Notfall- und Katastrophenmedizin, Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Würzburg
| | | |
Collapse
|
33
|
Luján M, Ergan B. Guidelines for Chronic Non-invasive Ventilation in COPD: From Experience to Evidence. Arch Bronconeumol 2020; 57:158-159. [PMID: 32334854 DOI: 10.1016/j.arbres.2020.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/03/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Manel Luján
- Service of Pneumology, Hospital de Sabadell Corporació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain; Centro de Investigación Biomédica en Red (CIBERES), Spain.
| | - Begum Ergan
- Department of Pulmonary and Critical Care, Dokuz Eylul University, School of Medicine, Izmir, Turkey
| |
Collapse
|
34
|
Long-Term Noninvasive Ventilation in the Geneva Lake Area: Indications, Prevalence, and Modalities. Chest 2020; 158:279-291. [PMID: 32243941 DOI: 10.1016/j.chest.2020.02.064] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/11/2020] [Accepted: 02/03/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Noninvasive ventilation (NIV) is standard of care for chronic hypercapnic respiratory failure, but indications, devices, and ventilatory modes are in constant evolution. RESEARCH QUESTION To describe changes in prevalence and indications for NIV over a 15-year period; to provide a comprehensive report of characteristics of the population treated (age, comorbidities, and anthropometric data), mode of implementation and follow-up, devices, modes and settings used, physiological data, compliance, and data from ventilator software. STUDY DESIGN AND METHODS Cross-sectional observational study designed to include all subjects under NIV followed by all structures involved in NIV in the Cantons of Geneva and Vaud (1,288,378 inhabitants). RESULTS A total of 489 patients under NIV were included. Prevalence increased 2.5-fold since 2000 reaching 38 per 100,000 inhabitants. Median age was 71 years, with 31% being > 75 years of age. Patients had been under NIV for a median of 39 months and had an average of 3 ± 1.8 comorbidities; 55% were obese. COPD (including overlap syndrome) was the most important patient group, followed by obesity hypoventilation syndrome (OHS) (26%). Daytime Paco2 was most often normalized. Adherence to treatment was satisfactory, with 8% only using their device < 3.5 h/d. Bilevel positive pressure ventilators in spontaneous/timed mode was the default mode (86%), with a low use of autotitrating modes. NIV was initiated electively in 50% of the population, in a hospital setting in 82%, and as outpatients in 15%. INTERPRETATION Use of NIV is increasing rapidly in this area, and the population treated is aging, comorbid, and frequently obese. COPD is presently the leading indication followed by OHS. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT04054570; URL: www.clinicaltrials.gov.
Collapse
|
35
|
Valentin-Caius C, Corina-Ioana B, Ana-Maria Z, Florin-Dumitru M, Oana-Claudia D. Non-Invasive Ventilation in Stable Chronic Obstructive Pulmonary Disease. CURRENT RESPIRATORY MEDICINE REVIEWS 2019. [DOI: 10.2174/1573398x15666190104123054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The benefit of non-invasive ventilation (NIV) in stable chronic obstructive pulmonary
disease (COPD) remains controversial. However, there is increasingly more evidence of NIV
efficiency, especially high-flow NIV. This review presents the old and the new evidence of NIV
effectiveness in stable COPD, considering pathophysiological arguments for NIV in COPD.
Guidelines, randomized controlled trials (RCTs) and crossover studies included in review and
metaanalysis based on patient-reported outcomes (PROs) have been analyzed. The role of NIV in
rehabilitation and in palliative care and the role of telemedicine in relation with NIV are still up for
debate. Challenges in choosing the right device and the optimal mode of ventilation still exist. There
are also discussions on the criteria for patient inclusion and on how to meet them. More studies are
needed to determine the ideal candidate for chronic NIV and to explain all the benefits of using NIV.
Collapse
Affiliation(s)
- Cosei Valentin-Caius
- Pneumology “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Borcea Corina-Ioana
- Pneumology “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | - Deleanu Oana-Claudia
- Pneumology “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| |
Collapse
|
36
|
Huang H, Feng H, Zhuge D. M1 Macrophage Activated by Notch Signal Pathway Contributed to Ventilator-Induced Lung Injury in Chronic Obstructive Pulmonary Disease Model. J Surg Res 2019; 244:358-367. [PMID: 31323391 DOI: 10.1016/j.jss.2019.06.060] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/10/2019] [Accepted: 06/14/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Ventilator-induced lung injury (VILI) in chronic obstructive pulmonary disease (COPD) is still a problem. We intended to explore the role of macrophage polarity in VILI and the underlying mechanism. MATERIALS AND METHODS COPD model was created by cigarette smoke and ventilated. Macrophages were isolated, and the wet/dry (W/D) ratio was determined after modeling, and proteins in bronchoalveolar lavage fluid (BALF) were assessed by bicinchoninic acid assay. Histopathology was observed by Hematoxylin-Eosin staining. Tumor necrosis factor (TNF)-α and interleukin (IL)-6 levels were measured by enzyme-linked immunosorbent assay. Macrophage polarity was assessed by flow cytometry. Protein levels were measured by Western blot and mRNA by quantitative real-time polymerase chain reaction. RESULTS Pathology statement was worsened, and the W/D ratio, protein level in BALF, TNF-α level, and IL-6 levels were elevated in cigarette smoke-induced COPD model. Notch-1 intracellular domain, hairy and enhancer of split (Hes) 1, Hes5, hairy/enhancer-of-split related with YRPW motif protein 1, CD86, TNF-α, and inducible nitric oxide synthases expressions were raised, whereas CD206, IL-4, and IL-10 expressions were decreased in macrophages after ventilation, shifting macrophage polarity to M1 phenotype. After the inhibition of Notch signaling, pathology statement was improved, and the W/D ratio, protein level in BALF, TNF-α, IL-6, Notch-1 intracellular domain, Hes1, Hes5, hairy/enhancer-of-split related with YRPW motif protein 1, CD86, TNF-α, and inducible nitric oxide synthases expressions were decreased while CD206, IL-4, and IL-10 expressions were elevated after ventilation, shifting macrophage polarity to M2 phenotype partially. CONCLUSIONS Mechanical ventilation in cigarette-induced COPD could activate the Notch signal pathway and further shift the polarity of macrophage toward M1 phenotype, leading to VILI in cigarette-induced COPD.
Collapse
Affiliation(s)
- Hongping Huang
- Department of Eastern Respiratory Medicine, Linyi People's Hospital, Linyi, China
| | - Hui Feng
- Linyi People's Hospital Office, Linyi People's Hospital, Linyi, China.
| | - Dong Zhuge
- Department of Eastern General Internal Medicine, Linyi People's Hospital, Linyi, China
| |
Collapse
|
37
|
Vukoja M, Kopitovic I, Lazic Z, Milenkovic B, Stankovic I, Zvezdin B, Dudvarski Ilic A, Cekerevac I, Vukcevic M, Zugic V, Hromis S. Diagnosis and management of chronic obstructive pulmonary disease in Serbia: an expert group position statement. Int J Chron Obstruct Pulmon Dis 2019; 14:1993-2002. [PMID: 31564847 PMCID: PMC6730542 DOI: 10.2147/copd.s214690] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/01/2019] [Indexed: 12/26/2022] Open
Abstract
In recent years, several national chronic obstructive pulmonary disease (COPD) guidelines have been issued. In Serbia, the burden of COPD is high and most of the patients are diagnosed at late stages. Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy is poorly implemented in real-life practice, as many patients are still prescribed inhaled corticosteroids (ICS)-containing regimens and slow-release theophylline. In this document, we propose an algorithm for treating COPD patients in Serbia based on national experts’ opinion, taking into account global recommendations and recent findings from clinical trials that are tailored according to local needs. We identified four major components of COPD treatment based on country specifics: active case finding and early diagnosis in high-risk population, therapeutic algorithm for initiation and escalation of therapy that is simple and easy to use in real-life practice, de-escalation of ICS in low-risk non-exacerbators, and individual choice of inhaler device based on patients' ability and preferences. With this approach we aim to facilitate implementation of the recommendation, initiate the treatment in early stages, improve cost-effectiveness, reduce possible side effects, and ensure efficient treatment.
Collapse
Affiliation(s)
- Marija Vukoja
- The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Ivan Kopitovic
- The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Zorica Lazic
- Clinic for Pulmonology, Clinical Centre Kragujevac, Kragujevac, Serbia.,Faculty of Medicine, University of Kragujevac, Kragujevac, Serbia
| | - Branislava Milenkovic
- Clinic for Pulmonology, Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Stankovic
- Clinic for Lung Diseases, Clinical Centre of Nis, Nis, Serbia.,Faculty of Medicine, University of Nis, Nis, Serbia
| | - Biljana Zvezdin
- The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Aleksandra Dudvarski Ilic
- Clinic for Pulmonology, Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Cekerevac
- Clinic for Pulmonology, Clinical Centre Kragujevac, Kragujevac, Serbia.,Faculty of Medicine, University of Kragujevac, Kragujevac, Serbia
| | - Miodrag Vukcevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Hospital Centre Zemun, Belgrade, Serbia
| | - Vladimir Zugic
- Clinic for Pulmonology, Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sanja Hromis
- The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| |
Collapse
|
38
|
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.
Collapse
|
39
|
Is positive airway pressure therapy underutilized in chronic obstructive pulmonary disease patients? Expert Rev Respir Med 2019; 13:407-415. [PMID: 30704303 DOI: 10.1080/17476348.2019.1577732] [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: 10/27/2022]
Abstract
INTRODUCTION The role of noninvasive positive pressure ventilation (NIPPV) in patients with stable chronic obstructive pulmonary disease (COPD) in the home-setting remains controversial. Despite studies suggesting potential benefits, there is an apparent underutilization of such therapy in patients with stable COPD in a domiciliary setting. Areas covered: The reasons for underutilization in the home-setting are multifactorial, and we provide our perspective on the adequacy of scientific evidence and implementation barriers that may underlie the observed underutilization. In this article, we will discuss continuous PAP, bilevel PAP, and non-invasive positive pressure ventilation using a home ventilator (NIPPV). Expert commentary: Many patients with stable COPD and chronic respiratory failure do not receive NIPPV therapy at home despite supportive scientific evidence. Such underutilization suggests that there are barriers to implementation that include provider knowledge, health services, and payor policies. For patients with stable COPD without chronic respiratory failure, there is inadequate scientific evidence to support domiciliary NIPPV or CPAP therapy. In patients with stable COPD without chronic respiratory failure, studies aimed at identifying patient characteristics that determine the effectiveness of domiciliary NIPPV therapy needs further study. Future implementation and health-policy research with appropriate stakeholders are direly needed to help improve patient outcomes.
Collapse
|
40
|
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
| |
Collapse
|
41
|
Menadue C, Piper AJ. Pressuring stable patients with hypercapnic COPD to exercise. Respirology 2018; 24:195-196. [PMID: 30548957 DOI: 10.1111/resp.13454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 11/22/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Collette Menadue
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Amanda J Piper
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Faulty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
42
|
Raveling T, Bladder G, Vonk JM, Nieuwenhuis JA, Verdonk-Struik FM, Wijkstra PJ, Duiverman ML. Improvement in hypercapnia does not predict survival in COPD patients on chronic noninvasive ventilation. Int J Chron Obstruct Pulmon Dis 2018; 13:3625-3634. [PMID: 30464445 PMCID: PMC6219270 DOI: 10.2147/copd.s169951] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose It has recently been shown that chronic noninvasive ventilation (NIV) improves a number of outcomes including survival, in patients with stable hypercapnic COPD. However, the mechanisms responsible for these improved outcomes are still unknown. The aim of the present study was to identify parameters associated with: 1) an improved arterial partial pressure of carbon dioxide (PaCO2) and 2) survival, in a cohort of hypercapnic COPD patients treated with chronic NIV. Patients and methods Data from 240 COPD patients treated with chronic NIV were analyzed. Predictors for the change in PaCO2 and survival were investigated using multivariate linear and Cox regression models, respectively. Results A higher level of bicarbonate before NIV initiation, the use of higher inspiratory ventilator pressures, the presence of anxiety symptoms, and NIV initiated following an exacerbation compared to NIV initiated in stable disease were associated with a larger reduction in PaCO2. A higher body mass index, a higher FEV1, a lower bicarbonate before NIV initiation, and younger age and NIV initiation in stable condition were independently associated with better survival. The change in PaCO2 was not associated with survival, neither in a subgroup of patients with a PaCO2 >7.0 kPa before the initiation of NIV. Conclusion Patients with anxiety symptoms and a high bicarbonate level at NIV initiation are potentially good responders in terms of an improvement in hypercapnia. Also, higher inspiratory ventilator pressures are associated with a larger reduction in PaCO2. However, the improvement in hypercapnia does not seem to be associated with an improved survival and emphasizes the need to look beyond PaCO2 when considering NIV initiation.
Collapse
Affiliation(s)
- Tim Raveling
- Faculty of Medical Sciences, University of Groningen, Groningen, the Netherlands
| | - Gerrie Bladder
- Department of Pulmonary Diseases and Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands,
| | - Judith M Vonk
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, the Netherlands, .,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jellie A Nieuwenhuis
- Department of Pulmonary Diseases and 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,
| | | | - Peter J Wijkstra
- Department of Pulmonary Diseases and 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 and 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,
| |
Collapse
|
43
|
Toujani S, Dabboussi S, Snene H, Mjid M, Kamoun S, Hedhli A, Cheikh Rouhou S, Cheikh R, Beji M, Ouahchi Y, Cherif J. [Home non-invasive ventilation for chronic obstructive pulmonary disease]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:235-241. [PMID: 29650284 DOI: 10.1016/j.pneumo.2018.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 03/17/2018] [Accepted: 03/19/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The benefits of long-term non-invasive ventilation (NIV) in the management of chronic obstructive pulmonary disease (COPD) patients remain controversial. AIM To analyze the characteristics of COPD patients under home NIV and to evaluate its impact among this population. METHODS We carried out a retrospective study between January 2002 and April 2016 of COPD patients under long-term NIV at "la Rabta" and the Military Hospital. RESULTS There were 27 patients with an average age of 64 and a sex ratio (M/F) of 0.92. Active smoking was reported in 96.3%. A persistent hypercapnia following an acute exacerbation of COPD with failure to wean the NIV was the main indication of long-term NIV. We noted a reduction in hospital admissions in the first year of 60% and in intensive care of 83.3% (P<10-3). There was no non-significant decrease of PaCO2 (4.5mmHg). There was no modification in FEV 1 and in FVC (P>0.05). The survival rate was 96.3% at 1 year, 83.3% at 2 years and a median survival of 24 months. CONCLUSIONS Our study suggests that home NIV contributes to the stabilization of some COPD patients by reducing the hospitalizations rates for exacerbation. More prospective studies are needed to better assess the impact of NIV on survival and quality of life and to better define the COPD patients who require NIV.
Collapse
Affiliation(s)
- S Toujani
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital la Rabta, UR12SP096 Tunis, Tunisie.
| | - S Dabboussi
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital Militaire, Tunis, Tunisie
| | - H Snene
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital la Rabta, UR12SP096 Tunis, Tunisie
| | - M Mjid
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital la Rabta, UR12SP096 Tunis, Tunisie
| | - S Kamoun
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital la Rabta, UR12SP096 Tunis, Tunisie
| | - A Hedhli
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital la Rabta, UR12SP096 Tunis, Tunisie
| | - S Cheikh Rouhou
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital la Rabta, UR12SP096 Tunis, Tunisie
| | - R Cheikh
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital Militaire, Tunis, Tunisie
| | - M Beji
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital la Rabta, UR12SP096 Tunis, Tunisie
| | - Y Ouahchi
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital la Rabta, UR12SP096 Tunis, Tunisie
| | - J Cherif
- Service de pneumologie, faculté de médecine de Tunis, université Tunis el Manar, hôpital la Rabta, UR12SP096 Tunis, Tunisie
| |
Collapse
|
44
|
Yazar EE, Özlü T, Sarıaydın M, Taylan M, Ekici A, Aydın D, Coşgun İG, Durmuş Koçak N. Prospective cross-sectional multicenter study on domiciliary noninvasive ventilation in stable hypercapnic COPD patients. Int J Chron Obstruct Pulmon Dis 2018; 13:2367-2374. [PMID: 30127600 PMCID: PMC6089109 DOI: 10.2147/copd.s164384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Domiciliary noninvasive ventilation (NIV) use in stable hypercarbic COPD is becoming increasingly widespread. However, treatment compliance criteria and factors related to compliance remain to be defined. Methods This research was designed as a prospective, cross-sectional, multicenter real-life study. Chronic hypercapnic COPD patients who were using domiciliary NIV for at least 1 year and being followed up in 19 centers across Turkey were included in the study. The patients who used NIV regularly, night or daytime and ≥5 hours/d, were classified as “high-compliance group,” and patients who used NIV irregularly and <5 hours/d as “low-compliance group.” Results Two hundred and sixty-six patients with a mean age of 64.5±10.3 years were enrolled, of whom 75.2% were males. They were using domiciliary NIV for 2.8±2 years. Spontaneous time mode (p<0.001) and night use (p<0.001) were more frequent in the high-compliance group (n=163). Also, mean inspiratory positive airway pressure values of the high-compliance group were significantly higher than the low-compliance group (n=103; p<0.001). Cardiac failure (p=0.049) and obesity (p=0.01) were significantly more frequent in the high-compliance group. There were no difference between 2 groups regarding hospitalization, emergency department and intensive care unit admissions within the last year, as well as modified Medical Research Council dyspnea and COPD Assessment Test scores. With regard to NIV-related side effects, only conjunctivitis was observed more frequently in the high-compliance group (p=0.002). Conclusion Determination of the patients who have better compliance to domiciliary NIV in COPD may increase the success and effectiveness of treatment. This highly comprehensive study on this topic possesses importance as it suggests that patient and ventilator characteristics may be related to treatment compliance.
Collapse
Affiliation(s)
- Esra Ertan Yazar
- Department of Pulmonology, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey,
| | - Tevfik Özlü
- Department of Pulmonology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Muzaffer Sarıaydın
- Department of Pulmonology, School of Medicine, Afyon Kocatepe University, Afyon, Turkey
| | - Mahşuk Taylan
- Department of Pulmonology, School of Medicine, Dicle University, Diyarbakır, Turkey
| | - Aydanur Ekici
- Department of Pulmonology, School of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Derya Aydın
- Department of Pulmonology, Balıkesir Chest Disease Government Hospital, Balıkesir, Turkey
| | - İbrahim Güven Coşgun
- Department of Pulmonology, Afyonkarahisar Government Hospital, Afyonkarahisar, Turkey
| | - Nagihan Durmuş Koçak
- Department of Pulmonology, Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
45
|
Zikyri A, Pastaka C, Gourgoulianis KI. Hypercapnic COPD patients and NIV at home: is there any benefit? Using the CAT and BODE index in an effort to prove benefits of NIV in these patients. Int J Chron Obstruct Pulmon Dis 2018; 13:2191-2198. [PMID: 30140151 PMCID: PMC6054756 DOI: 10.2147/copd.s152574] [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: 11/23/2022] Open
Abstract
Introduction The benefits of long-term noninvasive ventilation (NIV) in stable COPD with chronic hypercapnic respiratory failure (CHRF) have been debated for many years due to the conflicting results observed in these patients. Materials and methods We investigated the effects of domiciliary NIV in stable hypercapnic COPD patients for a period of 1 year using COPD Assessment Test (CAT), BODE Index, and the number of acute exacerbations. NIV was administered in 57 stable COPD patients with CHRF in the spontaneous/timed mode. Spirometry, 6 minute walk test, Medical Research Council dyspnea scale, arterial blood gases, number of acute exacerbations, BODE Index, and CAT were assessed. Study participants were reassessed in the 1st, 6th, and 12th months after the initial evaluation. Results There was a significant improvement in COPD exacerbations (p<0.001), CAT (p<0.001), PO2 (p<0.001), PCO2 (p<0.001), and Medical Research Council dyspnea scale (p<0.001) in 1 year of follow-up. BODE Index was improved in the first 6 months (5.8±2.2 vs 4.8±2.4, p<0.001), but the improvement was not maintained. Conclusion In conclusion, domiciliary NIV in stable COPD patients with CHRF has beneficial effect on CAT, arterial blood gases, and number of acute exacerbations in a year of NIV use at home. A significant improvement in BODE Index from baseline to 12 months was found in patients aged >70 years, while for those aged <70, the improvement was not maintained after the sixth month.
Collapse
Affiliation(s)
- Andriani Zikyri
- Department of Pulmonology, University Hospital of Larissa, Larissa, Greece,
| | - Chaido Pastaka
- Department of Pulmonology, University Hospital of Larissa, Larissa, Greece,
| | | |
Collapse
|
46
|
Oga T, Windisch W, Handa T, Hirai T, Chin K. Health-related quality of life measurement in patients with chronic respiratory failure. Respir Investig 2018; 56:214-221. [PMID: 29773292 DOI: 10.1016/j.resinv.2018.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/15/2018] [Accepted: 01/28/2018] [Indexed: 06/08/2023]
Abstract
The improvement of health-related quality of life (HRQL) is an important goal in managing patients with chronic respiratory failure (CRF) receiving long-term oxygen therapy (LTOT) and/or domiciliary noninvasive ventilation (NIV). Two condition-specific HRQL questionnaires have been developed to specifically assess these patients: the Maugeri Respiratory Failure Questionnaire (MRF) and the Severe Respiratory Insufficiency Questionnaire (SRI). The MRF is more advantageous in its ease of completion; conversely, the SRI measures diversified health impairments more multi-dimensionally and discriminatively with greater balance, especially in patients receiving NIV. The SRI is available in many different languages as a result of back-translation and validation processes, and is widely validated for various disorders such as chronic obstructive pulmonary disease, restrictive thoracic disorders, neuromuscular disorders, and obesity hypoventilation syndrome, among others. Dyspnea and psychological status were the main determinants for both questionnaires, while the MRF tended to place more emphasis on activity limitations than SRI. In comparison to existing generic questionnaires such as the Medical Outcomes Study 36-item short form (SF-36) and disease-specific questionnaires such as the St. George's Respiratory Questionnaire (SGRQ) and the Chronic Respiratory Disease Questionnaire (CRQ), both the MRF and the SRI have been shown to be valid and reliable, and have better discriminatory, evaluative, and predictive features than other questionnaires. Thus, in assessing the HRQL of patients with CRF using LTOT and/or NIV, we might consider avoiding the use of the SF-36 or even the SGRQ or CRQ alone and consider using the CRF-specific SRI and MRF in addition to existing generic and/or disease-specific questionnaires.
Collapse
Affiliation(s)
- Toru Oga
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, 54, Kawahara, Shogoin, Sakyo-ku, Kyoto, Japan.
| | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany.
| | - Tomohiro Handa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, 54, Kawahara, Shogoin, Sakyo-ku, Kyoto, Japan.
| |
Collapse
|
47
|
Tomasic I, Tomasic N, Trobec R, Krpan M, Kelava T. Continuous remote monitoring of COPD patients-justification and explanation of the requirements and a survey of the available technologies. Med Biol Eng Comput 2018; 56:547-569. [PMID: 29504070 PMCID: PMC5857273 DOI: 10.1007/s11517-018-1798-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 01/30/2018] [Indexed: 01/03/2023]
Abstract
Remote patient monitoring should reduce mortality rates, improve care, and reduce costs. We present an overview of the available technologies for the remote monitoring of chronic obstructive pulmonary disease (COPD) patients, together with the most important medical information regarding COPD in a language that is adapted for engineers. Our aim is to bridge the gap between the technical and medical worlds and to facilitate and motivate future research in the field. We also present a justification, motivation, and explanation of how to monitor the most important parameters for COPD patients, together with pointers for the challenges that remain. Additionally, we propose and justify the importance of electrocardiograms (ECGs) and the arterial carbon dioxide partial pressure (PaCO2) as two crucial physiological parameters that have not been used so far to any great extent in the monitoring of COPD patients. We cover four possibilities for the remote monitoring of COPD patients: continuous monitoring during normal daily activities for the prediction and early detection of exacerbations and life-threatening events, monitoring during the home treatment of mild exacerbations, monitoring oxygen therapy applications, and monitoring exercise. We also present and discuss the current approaches to decision support at remote locations and list the normal and pathological values/ranges for all the relevant physiological parameters. The paper concludes with our insights into the future developments and remaining challenges for improvements to continuous remote monitoring systems. Graphical abstract ᅟ.
Collapse
Affiliation(s)
- Ivan Tomasic
- Division of Intelligent Future Technologies, Mälardalen University, Högskoleplan 1, 72123, Västerås, Sweden.
| | - Nikica Tomasic
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Roman Trobec
- Department of Communication Systems, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Miroslav Krpan
- Department of Cardiology, University Hospital Centre, Zagreb, Croatia
| | - Tomislav Kelava
- Department of Physiology, School of Medicine, University of Zagreb, Zagreb, Croatia
| |
Collapse
|
48
|
Duiverman ML. Noninvasive ventilation in stable hypercapnic COPD: what is the evidence? ERJ Open Res 2018; 4:00012-2018. [PMID: 29637078 PMCID: PMC5890025 DOI: 10.1183/23120541.00012-2018] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 01/27/2018] [Indexed: 12/21/2022] Open
Abstract
Long-term noninvasive ventilation (NIV) to treat chronic hypercapnic respiratory failure is still controversial in severe chronic obstructive pulmonary disease (COPD) patients. However, with the introduction of high-intensity NIV, important benefits from this therapy have also been shown in COPD. In this review, the focus will be on the arguments for long-term NIV at home in patients with COPD. The rise of (high-intensity) NIV in COPD and the randomised controlled trials showing positive effects with this mode of ventilation will be discussed. Finally, the challenges that might be encountered (both in clinical practice and in research) in further optimising this therapy, monitoring and following patients, and selecting the patients who might benefit most will be reviewed.
Collapse
Affiliation(s)
- Marieke L. Duiverman
- Dept of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute of Asthma and COPD, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
49
|
Storre JH, Callegari J, Magnet FS, Schwarz SB, Duiverman ML, Wijkstra PJ, Windisch W. Home noninvasive ventilatory support for patients with chronic obstructive pulmonary disease: patient selection and perspectives. Int J Chron Obstruct Pulmon Dis 2018. [PMID: 29535515 PMCID: PMC5836655 DOI: 10.2147/copd.s154718] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Long-term or home mechanical noninvasive ventilation (Home-NIV) has become a well-established form of therapy over the last few decades for chronic hypercapnic COPD patients in European countries. However, meta-analyses and clinical guidelines do not recommend Home-NIV for COPD patients on a routine basis. In particular, there is ongoing debate about Home-NIV in chronic hypercapnic COPD regarding the overall effects, the most favorable treatment strategy, the selection of eligible patients, and the time point at which it is prescribed. The current review focuses on specific aspects of patient selection and discusses the various scientific as well as clinical-guided perspectives on Home-NIV in patients suffering from chronic hypercapnic COPD. In addition, special attention will be given to the topic of ventilator settings and interfaces.
Collapse
Affiliation(s)
- Jan Hendrik Storre
- Department of Intensive Care, Sleep Medicine and Mechanical Ventilation, Asklepios Fachkliniken Munich-Gauting, Gauting, Germany.,Department of Pneumology, University Medical Hospital, Freiburg, Germany
| | - Jens Callegari
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
| | - Friederike Sophie Magnet
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
| | - Sarah Bettina Schwarz
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
| | - Marieke Leontine Duiverman
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, the Netherlands
| | - Peter Jan Wijkstra
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, the Netherlands
| | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
| |
Collapse
|
50
|
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.
Collapse
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
| |
Collapse
|