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Jeganathan V, Rautela L, Conti S, Saravanan K, Rigoni A, Graco M, Hannan LM, Howard ME, Berlowitz DJ. Typical within and between person variability in non-invasive ventilator derived variables among clinically stable, long-term users. BMJ Open Respir Res 2021; 8:8/1/e000824. [PMID: 33664121 PMCID: PMC7934749 DOI: 10.1136/bmjresp-2020-000824] [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: 11/04/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 12/11/2022] Open
Abstract
Background Despite increasing capacity to remotely monitor non-invasive ventilation (NIV), how remote data varies from day to day and person to person is poorly described. Methods Single-centre, 2-month, prospective study of clinically stable adults on long-term NIV which aimed to document NIV-device variability. Participants were switched to a ventilator with tele-monitoring capabilities. Ventilation settings and masking were not altered. Raw, extensible markup language data files were provided directly from Philips Respironics (EncoreAnywhere). A nested analysis of variance was conducted on each ventilator variable to apportion the relative variation between and within participants. Results Twenty-nine people were recruited (four withdrew, one had insufficient data for analyses; 1364 days of data). Mean age was 54.0 years (SD 18.4), 58.3% male with body mass index of 37.0 kg/m2 (13.7). Mean adherence was 8.53 (2.23) hours/day and all participants had adherence >4 hours/day. Variance in ventilator-derived indices was predominantly driven by differences between participants; usage (61% between vs 39% within), Apnoea–Hypopnoea Index (71% vs 29%), unintentional (64% vs 36%) and total leak (83% vs 17%), tidal volume (93% vs 7%), minute ventilation (92% vs 8%), respiratory rate (92% vs 8%) and percentage of triggered breaths (93% vs 7%). Interpretation In this clinically stable cohort, all device-derived indices were more varied between users than the day-to-day variation within individuals. We speculate that normative ranges and thresholds for clinical intervention need to be individualised, and further research is necessary to determine the clinically important relationships between clinician targets for therapy and patient-reported outcomes.
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Affiliation(s)
- Vishnu Jeganathan
- Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Linda Rautela
- Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Department of Physiotherapy, Austin Health, Heidelberg, Victoria, Australia
| | - Simon Conti
- Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Krisha Saravanan
- Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Alyssa Rigoni
- Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Marnie Graco
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Liam M Hannan
- Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Respiratory Medicine, Northern Health, Epping, Victoria, Australia
| | - Mark E Howard
- Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - David J Berlowitz
- Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia .,Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
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Abstract
Many neuromuscular disorders (NMD) are complicated by respiratory failure. These patients are best managed in a multidisciplinary outpatient clinic to provide timely access to the various disciplines they require. The key mainstay of treatment of respiratory failure in patients with NMD is noninvasive ventilation, supported by secretion clearance, speech and language therapy, optimisation of nutrition and the maintenance of mobility. Patients with specific conditions may also require cardiology, neurology, orthopaedics, urology and psychological services. The respiratory NMD multidisciplinary team should also provide access to palliative care, and caregiver health and wellbeing should also be reviewed at clinical reviews. The future of care for the respiratory NMD patient will increasingly involve home services and telehealth and the clinic should be equipped and resourced to deliver these. Although not all health systems will be able to provide all elements of the multidisciplinary team discussed here, this review provides the “ideal” recipe for the adult multidisciplinary team and the evidence base underpinning this from which a clinic can be developed. Care for neuromuscular-related respiratory failure is complex and is best delivered in a multidisciplinary context. The future will increasingly involve home services and telehealth, and their burden needs to be considered when establishing this service.https://bit.ly/33fNsMT
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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
| | - Patrick B Murphy
- 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
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Perrem L, Mehta K, Syed F, Baker A, Amin R. How to use noninvasive positive airway pressure device data reports to guide clinical care. Pediatr Pulmonol 2020; 55:58-67. [PMID: 31671252 DOI: 10.1002/ppul.24555] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 10/05/2019] [Indexed: 12/25/2022]
Abstract
There has been a significant increase in the past few decades in the number of children receiving noninvasive positive airway pressure (PAP) therapy at home. At present, PAP therapy can be successfully used in children of all ages, for a variety of indications. Data acquired from PAP devices is clinically useful, providing objective information regarding adherence, leak, and efficacy of PAP therapy. However, guidelines outlining a standardized approach to interpretation of PAP device data in pediatrics is currently lacking. Given the rapidly expanding use of PAP therapy in pediatric practice, we aim to provide an overview of the interpretation of data reports, otherwise called "data downloads," from PAP devices and illustrate how they can be used to guide clinical care.
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Affiliation(s)
- Lucy Perrem
- Division of Respiratory Medicine, Department of Pediatrics, SickKids, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Kevan Mehta
- Division of Respiratory Medicine, Department of Pediatrics, SickKids, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Faiza Syed
- Division of Respiratory Medicine, Department of Pediatrics, SickKids, Toronto, Canada
| | - Adele Baker
- Division of Respiratory Medicine, Department of Pediatrics, SickKids, Toronto, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, Department of Pediatrics, SickKids, Toronto, Canada.,University of Toronto, Toronto, Canada
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