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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: 17] [Impact Index Per Article: 8.5] [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.
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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
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Britton D, Pullen E, Hoit JD, Benditt JO. Effects of Mouthpiece Noninvasive Ventilation on Speech in Men With Muscular Dystrophy: A Pilot Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1373-1381. [PMID: 33651948 DOI: 10.1044/2020_ajslp-20-00146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The use of noninvasive ventilation (NIV) is on the rise as an alternative to tracheostomy for individuals with neuromuscular disorders with life-prolonging and quality-of-life benefits. This pilot study was designed to determine if mouthpiece NIV (M-NIV) alters speech in individuals with muscular dystrophy (MD). Method Eight men (23-44 years), seven with Duchenne MD and one with Becker MD, who used daytime M-NIV, were asked to sustain phonation, count, and read under three conditions: (a) Uncued (no instructions), (b) With M-NIV (cued to use M-NIV with all speaking breaths), and (c) Without M-NIV (as tolerated). Breath group and inspiratory durations, syllables/breath group, and relative sound pressure level were determined from audio and video recordings. Results Uncued condition: Participants used the ventilator for all inspirations that preceded sustained phonation and counting. During reading, four participants used M-NIV for all inspirations, one never used it, and three used it for some (19%-41%) inspirations. With- versus Without-M-NIV conditions: Breath group duration was significantly longer across all tasks, syllables per breath group were significantly greater during reading, and inspiratory pause duration during reading was significantly longer with M-NIV than without. Sound pressure level was significantly higher during the first second of sustained phonation with M-NIV (though not for counting and reading). Two participants were unable to complete the reading task audibly without using their M-NIV. Conclusions Speech may be better with M-NIV than without because it is possible to produce longer breath groups and some people with severe respiratory muscle weakness may not be able to speak at all without ventilator-supplied air. Nevertheless, the longer inspiratory pauses that accompany M-NIV may interrupt the flow of speech. Future research is needed to determine the most effective way to use M-NIV for speaking and whether training participants in its use can bring even greater speech benefits.
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Affiliation(s)
- Deanna Britton
- Department of Speech and Hearing Sciences, Portland State University, OR
- Northwest Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland
- Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle
| | | | - Jeannette D Hoit
- Department of Speech, Language and Hearing Sciences, University of Arizona, Tucson
| | - Joshua O Benditt
- Division of Pulmonary and Critical Care Medicine, University of Washington Medical Center, Seattle
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Léotard A, Lebret M, Daabek N, Prigent H, Destors M, Saint-Raymond C, Sagniez A, Leroux K, Tamisier R, Lofaso F, Pépin JL, Borel JC. Impact of Interface Type on Noninvasive Ventilation Efficacy in Patients With Neuromuscular Disease: A Randomized Cross-Over Trial. Arch Bronconeumol 2020; 57:273-280. [PMID: 32586702 DOI: 10.1016/j.arbres.2020.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/03/2020] [Accepted: 05/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Around 25% of patients with neuro-muscular diseases (NMD) are treated by home noninvasive ventilation (NIV) through an oronasal mask. However, there is growing evidence that nasal masks require lower NIV pressures and result in fewer residual obstructive events. We hypothesized that nasal masks would improve efficacy and reduce side effects compared to oronasal masks in this population. METHODS open label, cross-over, randomized, study in 2 tertiary care hospitals. Patients with NMD treated by home NIV were randomized for one-week periods to nasal and oronasal interfaces respectively (cross-over). At the end of each period, nocturnal polygraphy (monitoring mouth opening) under NIV, synchronized with transcutaneous partial pressure in CO2 (tcCO2) was performed. Data were collected from the NIV built-in software and NIV side-effects were collected. Intention-to-treat and per protocol analyses were performed. The primary outcome was mean nocturnal SpO2. The secondary outcomes were: percentage of sleep with SpO2<90%, oxygen desaturation index (ODI), mean tcCO2, mean duration of mouth opening during sleep, level of non-intentional leaks and side-effects. RESULTS Thirty patients with NMD were included. There were no between-group differences for either the primary or secondary outcomes. Post hoc comparisons showed that changing between interfaces reduced NIV efficacy: mean nocturnal SpO2 (p=0.04), ODI (p=0.01), mean tcCO2 (p=0.048), side-effects (p=0.008). CONCLUSION Nasal masks did not improve NIV efficacy or reduce side effects compared to oronasal masks in patients with NMD treated by home NIV. The efficacy of NIV is reduced during the transition to another interface, requiring close monitoring. Registration number: NCT03458507.
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Affiliation(s)
- Antoine Léotard
- Département de physiologie, explorations fonctionnelles, unité des pathologies du sommeil, AP-HP, Hôpital Raymond Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches, France; Université Versailles - Saint-Quentin-en-Yvelines, «End:icap» U1179 Inserm, UFR Des sciences de la sante - Simone-Veil, Versailles, France.
| | - Marius Lebret
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France; AGIR à dom. Association, Meylan F-38240, France
| | | | - Hélène Prigent
- Département de physiologie, explorations fonctionnelles, unité de physiologie respiratoire, AP-HP, Hôpital Raymond Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches, France; Université Versailles - Saint-Quentin-en-Yvelines, «End:icap» U1179 Inserm, UFR Des sciences de la sante - Simone-Veil, Versailles, France
| | - Marie Destors
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France; Laboratoire Sommeil et exercice, pole thorax-vaisseaux, CHU Grenoble Alpes, France
| | | | - Amélie Sagniez
- Adep Assistance, Le Narval A1 - 29 rue des Hautes Pâtures, 92000 Nanterre, France
| | - Karl Leroux
- ASV Santé, 125, Avenue Louis Roche, 92230 Gennevilliers, France
| | - Renaud Tamisier
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France; Laboratoire Sommeil et exercice, pole thorax-vaisseaux, CHU Grenoble Alpes, France
| | - Frédéric Lofaso
- Département de physiologie, explorations fonctionnelles, unité de physiologie respiratoire, AP-HP, Hôpital Raymond Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches, France; Université Versailles - Saint-Quentin-en-Yvelines, «End:icap» U1179 Inserm, UFR Des sciences de la sante - Simone-Veil, Versailles, France
| | - Jean Louis Pépin
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France; Laboratoire Sommeil et exercice, pole thorax-vaisseaux, CHU Grenoble Alpes, France
| | - Jean Christian Borel
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France; AGIR à dom. Association, Meylan F-38240, France
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Leotard A, Lebret M, Prigent H, Arnol N, Pépin JL, Hartley S, Lofaso F, Borel JC. Facteurs associés au masque de ventilation non invasive nocturne chez les patients neuromusculaires adultes. Rev Mal Respir 2020; 37:99-104. [DOI: 10.1016/j.rmr.2019.11.646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/26/2019] [Indexed: 11/29/2022]
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Toussaint M, Chatwin M, Verhulst S, Reychler G. Preference of neuromuscular patients regarding equipment for daytime mouthpiece ventilation: A randomized crossover study. CLINICAL RESPIRATORY JOURNAL 2019; 14:214-221. [DOI: 10.1111/crj.13118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 11/13/2019] [Accepted: 11/29/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Michel Toussaint
- Centre for Home Mechanical Ventilation and Neuromuscular Disorders Department of Rehabilitation Rehabilitation Hospital Inkendaal Vlezenbeek Belgium
| | - Michelle Chatwin
- Clinical and Academic Department of Sleep and Breathing Royal Brompton Hospital S Foundation Trust Royal Brompton & Harefield NH London UK
| | - Stijn Verhulst
- Department of Pediatrics Antwerp University Hospital and Lab of Experimental Medicine and Pediatrics University of Antwerp Antwerp Belgium
| | - Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC) Université Catholique de Louvain Pôle de Pneumologie, ORL & Dermatologie Brussels Belgium
- Service de Pneumologie Cliniques Universitaires Saint‐Luc Brussels Belgium
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Crescimanno G, Greco F, D'Alia R, Messina L, Marrone O. Quality of life in long term ventilated adult patients with Duchenne muscular dystrophy. Neuromuscul Disord 2019; 29:569-575. [PMID: 31395305 DOI: 10.1016/j.nmd.2019.06.599] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/17/2019] [Accepted: 06/26/2019] [Indexed: 12/01/2022]
Abstract
The aim of this study was to evaluate quality of life (QoL) and its possible determinants in patients affected by Duchenne muscular dystrophy (DMD) in late stages of their disease, when non-invasive ventilation (NIV) is already established. Forty-eight DMD patients who were treated by NIV were enrolled. QoL was assessed by the Individualized Neuromuscular Quality of Life (INQoL) questionnaire. By this questionnaire, different aspects of QoL were assessed on a scale from 0 (best) to 100 (worst). In addition, motor and respiratory function tests were performed. Dysautonomia symptoms, sleep quality, sleepiness, anxiety, and depression were evaluated by validated questionnaires. The global INQoL score was 42.8 ± 19, reflecting a moderately altered QoL. The physical health domain was heavily impaired while the psychosocial domain was only mildly affected. Independence had the highest scores (81.1 ± 21.2), proving to be the most affected item. On multivariate analysis, maximal inspiratory pressure and Pittsburgh Sleep Quality Index, but not daily duration of NIV therapy, predicted global INQoL score. Respiratory impairment and sleep quality were independent predictors of poor QoL in DMD patients under NIV. Sleep quality in DMD is often disregarded, while it should be carefully addressed to ensure a better QoL.
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Affiliation(s)
- Grazia Crescimanno
- Italian National Research Council, Institute of Biomedicine and Molecular Immunology, Via Ugo La Malfa, 153, 90146 Palermo, Italy; Regional center for prevention and treatment of respiratory complications of rare genetic neuromuscular diseases, Villa Sofia-Cervello Hospital, Palermo, Italy.
| | | | | | - Luigi Messina
- Italian Union Against Muscular Dystrophy (UILDM), Italy
| | - Oreste Marrone
- Italian National Research Council, Institute of Biomedicine and Molecular Immunology, Via Ugo La Malfa, 153, 90146 Palermo, Italy
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Crimi C, Pierucci P, Carlucci A, Cortegiani A, Gregoretti C. Long-Term Ventilation in Neuromuscular Patients: Review of Concerns, Beliefs, and Ethical Dilemmas. Respiration 2019; 97:185-196. [PMID: 30677752 DOI: 10.1159/000495941] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/03/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Noninvasive mechanical ventilation (NIV) is an effective treatment in patients with neuromuscular diseases (NMD) to improve symptoms, quality of life, and survival. SUMMARY NIV should be used early in the course of respiratory muscle involvement in NMD patients and its requirements may increase over time. Therefore, training on technical equipment at home and advice on problem solving are warranted. Remote monitoring of ventilator parameters using built-in ventilator software is recommended. Telemedicine may be helpful in reducing hospital admissions. Anticipatory planning and palliative care should be carried out to lessen the burden of care, to maintain or withdraw from NIV, and to guarantee the most respectful management in the last days of NMD patients' life. Key Message: Long-term NIV is effective but challenging in NMD patients. Efforts should be made by health care providers in arranging a planned transition to home and end-of-life discussions for ventilator-assisted individuals and their families.
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Affiliation(s)
- Claudia Crimi
- Respiratory Medicine Unit, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Sleep Medicine Unit, Policlinico University Hospital, Bari, Italy
| | - Annalisa Carlucci
- Respiratory Intensive Care Unit, Pulmonary Rehabilitation Unit, IRCCS Fondazione S. Maugeri, Pavia, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy,
| | - Cesare Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
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Vianello A, Arcaro G, Molena B, Iovino S, Gallan F, Turato C, Marchese-Ragona R. Effect of a passive exhalation port on tracheostomy ventilation in amyotrophic lateral sclerosis patients: a randomized controlled trial. J Thorac Dis 2018; 10:1007-1014. [PMID: 29607174 DOI: 10.21037/jtd.2018.01.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Amyotrophic lateral sclerosis (ALS) patients often require long-term tracheostomy ventilation (LT-TV) because of progressive ventilatory failure. Although widely used for non-invasive ventilation (NIV), passive exhalation port systems have not been gaining popularity for TV because of the possibility of carbon dioxide (CO2) rebreathing. The current study set out to investigate the effect of a Whisper Swivel connector in comparison to an active exhalation valve on gas exchange and symptoms in ALS patients requiring LT-TV. Methods A prospective randomized controlled trial was carried out to compare the clinical outcome of ten ALS patients receiving LT-TV by means of a Trilogy 100 ventilator with a Whisper Swivel passive exhalation port (group A) and of 10 ALS patients connected to an Airox Legendair ventilator with an active exhalation valve (group B). The study's main outcome measure was CO2 retention at the 30-day follow-up assessment. Results One patient in each of the two cohorts showed significant CO2 retention. At the 30-day assessment, scores on the following measures were not significantly different in the two groups: the Borg dyspnea scale {2 [1-3] vs. 1 [1-3]; P=0.2891}, the visual analogue scale (VAS) dyspnea {20 [10-85] vs. 20 [0-50]; P=0.8571}, the Epworth sleepiness scale (ESS) {8 [4-10] vs. 5.5 [0-12]; P=0.1443}, the EuroQol-VAS (EQ-VAS) {55 [50-80] vs. 50 [30-80]; P=0.4593} and the relative stress scale (RSS) {49 [30-65] vs. 52 [25-64]; P=0.8650}. At the 3-month follow-up assessment, the numbers of hospitalizations and deaths were likewise similar in the two groups. Conclusions The efficacy of the Whisper Swivel connector is similar to that of an active exhalation valve in ALS patients undergoing LT-TV.
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Affiliation(s)
- Andrea Vianello
- Respiratory Pathophysiology and Intensive Care Unit, Department of Cardio-Thoracic, University-City Hospital of Padova, Padova, Italy
| | - Giovanna Arcaro
- Respiratory Pathophysiology and Intensive Care Unit, Department of Cardio-Thoracic, University-City Hospital of Padova, Padova, Italy
| | - Beatrice Molena
- Respiratory Pathophysiology and Intensive Care Unit, Department of Cardio-Thoracic, University-City Hospital of Padova, Padova, Italy
| | - Silvia Iovino
- Respiratory Pathophysiology and Intensive Care Unit, Department of Cardio-Thoracic, University-City Hospital of Padova, Padova, Italy
| | - Federico Gallan
- Respiratory Pathophysiology and Intensive Care Unit, Department of Cardio-Thoracic, University-City Hospital of Padova, Padova, Italy
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Terzi N, Lofaso F, Masson R, Beuret P, Normand H, Dumanowski E, Falaize L, Sauneuf B, Daubin C, Brunet J, Annane D, Parienti JJ, Orlikowski D. Physiological predictors of respiratory and cough assistance needs after extubation. Ann Intensive Care 2018; 8:18. [PMID: 29404723 PMCID: PMC5799095 DOI: 10.1186/s13613-018-0360-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 01/23/2018] [Indexed: 12/13/2022] Open
Abstract
Background Identifying patients at high risk of post-extubation acute respiratory failure requiring respiratory or mechanical cough assistance remains challenging. Here, our primary aim was to evaluate the accuracy of easily collected parameters obtained before or just after extubation in predicting the risk of post-extubation acute respiratory failure requiring, at best, noninvasive mechanical ventilation (NIV) and/or mechanical cough assistance and, at worst, reintubation after extubation.
Methods We conducted a multicenter prospective, open-label, observational study from April 2012 through April 2015. Patients who passed a weaning test after at least 72 h of endotracheal mechanical ventilation (MV) were included. Just before extubation, spirometry and maximal pressures were measured by a technician. The results were not disclosed to the bedside physicians. Patients were followed until discharge or death.
Results Among 3458 patients admitted to the ICU, 730 received endotracheal MV for longer than 72 h and were then extubated; among these, 130 were included. At inclusion, the 130 patients had mean ICU stay and endotracheal MV durations both equal to 11 ± 4.2 days. After extubation, 36 patients required curative NIV, 7 both curative NIV and mechanical cough assistance, and 8 only mechanical cough assistance; 6 patients, all of whom first received NIV, required reintubation within 48 h. The group that required NIV after extubation had a significantly higher proportion of patients with chronic respiratory disease (P = 0.015), longer endotracheal MV duration at inclusion, and lower Medical Research Council (MRC) score (P = 0.02, P = 0.01, and P = 0.004, respectively). By multivariate analysis, forced vital capacity (FVC) and peak cough expiratory flow (PCEF) were independently associated with (NIV) and/or mechanical cough assistance and/or reintubation after extubation. Areas under the ROC curves for pre-extubation PCEF and FVC were 0.71 and 0.76, respectively. Conclusion In conclusion, FVC measured before extubation correlates closely with FVC after extubation and may serve as an objective predictor of post-extubation respiratory failure requiring NIV and/or mechanical cough assistance and/or reintubation in heterogeneous populations of medical ICU patients. ClinicalTrials.gov as #NCT01564745 Electronic supplementary material The online version of this article (10.1186/s13613-018-0360-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicolas Terzi
- INSERM, Université Grenoble-Alpes, U1042, HP2, 38000, Grenoble, France. .,CHU Grenoble Alpes, Service de réanimation médicale, 38000, Grenoble, France. .,Service de réanimation médicale, Centre Hospitalier Universitaire Grenoble - Alpes, CS10217, Grenoble Cedex 09, France.
| | - Frédéric Lofaso
- Université de Versailles Saint Quentin en Yvelines, INSERM U1179, Garches, France.,CIC 1429, INSERM, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France.,Service d'Explorations Fonctionnelles Respiratoires, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France
| | - Romain Masson
- Service de réanimation médicale, Centre Hospitalier Universitaire Grenoble - Alpes, CS10217, Grenoble Cedex 09, France
| | - Pascal Beuret
- Service de Réanimation, Centre Hospitalier de Roanne, 42300, Roanne, France
| | - Hervé Normand
- INSERM, U1075, 14000, Caen, France.,Université de Caen, 14000, Caen, France.,CHRU Caen, Service d'Explorations Fonctionnelles Respiratoire, 14000, Caen, France
| | - Edith Dumanowski
- CHRU Caen, Service d'Explorations Fonctionnelles Respiratoire, 14000, Caen, France
| | - Line Falaize
- INSERM U 1179, Université de Versailles-Saint Quentin en Yvelines, 104 Bd Raymond Poincaré, 92380, Garches, France.,CIC 1429, Inserm-APHP, Hôpital Raymond Poincaré, 104 Bd Raymond Poincaré, 92380, Garches, France
| | - Bertrand Sauneuf
- Service de réanimation médicale, Centre Hospitalier Universitaire Grenoble - Alpes, CS10217, Grenoble Cedex 09, France.,Service de Réanimation Médicale Polyvalente, Centre Hospitalier Public du Cotentin, BP 208, 50102, Cherbourg-en-Cotentin, France
| | - Cédric Daubin
- Service de réanimation médicale, Centre Hospitalier Universitaire Grenoble - Alpes, CS10217, Grenoble Cedex 09, France
| | - Jennifer Brunet
- Service de réanimation médicale, Centre Hospitalier Universitaire Grenoble - Alpes, CS10217, Grenoble Cedex 09, France
| | - Djillali Annane
- General Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), Laboratory of Inflammation and Infection, U1173, INSERM and University of Versailles SQY, 92380, Garches, France
| | - Jean-Jacques Parienti
- Unité de Biostatistique et de Recherche Clinique, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France
| | - David Orlikowski
- Université de Versailles Saint Quentin en Yvelines, INSERM U1179, Garches, France.,CIC 1429, INSERM, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France.,Pôle de ventilation à domicile, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France.,Service de Santé Publique, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France
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Landfeldt E, Edström J, Lindgren P, Lochmüller H. Patient Preferences for Treatments of Neuromuscular Diseases: A Systematic Literature Review. J Neuromuscul Dis 2017; 4:285-292. [DOI: 10.3233/jnd-170271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Erik Landfeldt
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Mapi Group, Stockholm, Sweden
| | | | - Peter Lindgren
- Department of Learning, Informatics, Managementand Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Hanns Lochmüller
- MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
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Arellano-Maric MP, Gregoretti C, Duiverman M, Windisch W. Long-term volume-targeted pressure-controlled ventilation: sense or nonsense? Eur Respir J 2017. [PMID: 28642309 DOI: 10.1183/13993003.02193-2016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The technology underlying the development of novel ventilatory modes for long-term noninvasive ventilation of patients with chronic hypercapnia is continuously evolving. Volume-targeted pressure-controlled ventilation is a hybrid ventilation mode designed to combine the advantages of conventional ventilation modes, while avoiding their drawbacks. However, manufacturers have created different names and have patented algorithms and set-up variables, which can result in confusion for physicians and respiratory therapists. In addition, clear evidence for the superiority of this novel mode has not yet been established. These factors have most likely hindered more widespread use of this mode in clinical practice. The current review presents the rationale, working principles, characteristics and set-up recommendations associated with volume-targeted modes. In addition, it summarises the clinical and laboratory studies that have challenged this mode.
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Affiliation(s)
- Maria Paola Arellano-Maric
- Dept of Pneumology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Dept of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
| | - Cesare Gregoretti
- Dept of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico P. Giaccone. University of Palermo, Palermo, Italy
| | - Marieke Duiverman
- Dept of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany.,Dept of Pulmonary Diseases, University Medical Center Groningen, Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
| | - Wolfram Windisch
- Dept of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
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Ogna A, Prigent H, Falaize L, Leroux K, Santos D, Vaugier I, Orlikowski D, Lofaso F. Bench evaluation of commercially available and newly developed interfaces for mouthpiece ventilation. CLINICAL RESPIRATORY JOURNAL 2017; 12:890-894. [DOI: 10.1111/crj.12601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 11/15/2016] [Accepted: 12/01/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Adam Ogna
- Hôpital Raymond Poincaré, Service de Réanimation médicale et unité de ventilation à domicile; AP-HP; Garches 92380 France
| | - Helene Prigent
- Hôpital Raymond Poincaré, Service de Physiologie-Explorations Fonctionnelles; AP-HP; Garches 92380 France
| | - Line Falaize
- Hôpital Raymond Poincaré, Service de Physiologie-Explorations Fonctionnelles; AP-HP; Garches 92380 France
- AP-HP, Hôpital Raymond Poincaré, INSERM CIC 14.29; Garches 92380 France
| | | | - Dante Santos
- Hôpital Raymond Poincaré, Service de Physiologie-Explorations Fonctionnelles; AP-HP; Garches 92380 France
| | - Isabelle Vaugier
- AP-HP, Hôpital Raymond Poincaré, INSERM CIC 14.29; Garches 92380 France
| | - David Orlikowski
- Hôpital Raymond Poincaré, Service de Réanimation médicale et unité de ventilation à domicile; AP-HP; Garches 92380 France
- AP-HP, Hôpital Raymond Poincaré, INSERM CIC 14.29; Garches 92380 France
| | - Frederic Lofaso
- Hôpital Raymond Poincaré, Service de Physiologie-Explorations Fonctionnelles; AP-HP; Garches 92380 France
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Long-term non-invasive ventilation in children. THE LANCET RESPIRATORY MEDICINE 2016; 4:999-1008. [DOI: 10.1016/s2213-2600(16)30151-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/27/2016] [Accepted: 05/27/2016] [Indexed: 11/23/2022]
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Orlikowski D, Prigent H, Ambrosi X, Vaugier I, Pottier S, Annane D, Lofaso F, Ogna A. Comparison of ventilator-integrated end-tidal CO2 and transcutaneous CO2 monitoring in home-ventilated neuromuscular patients. Respir Med 2016; 117:7-13. [PMID: 27492508 DOI: 10.1016/j.rmed.2016.05.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 05/14/2016] [Accepted: 05/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Non-invasive transcutaneous capnometry (TcCO2) is used to assess the home ventilation's efficiency. Recently, end-tidal CO2 (ETCO2) sensors have been integrated in life-support home ventilators. The purpose of this study was to compare the ventilator-integrated ETCO2 with TcCO2, in home-ventilated neuromuscular disease patients. METHODS ETCO2 and TcCO2 were simultaneously measured during one night in 28 patients. Daytime blood gases were drawn on the following morning to measure arterial PCO2 (PaCO2). RESULTS Compared to PaCO2 values, both ETCO2 and TcCO2 showed a small bias (-0.1 mmHg and 0.6 mmHg, respectively) and a similar critical difference (6.8 mmHg and 7.3 mmHg, respectively). We found a good correlation between ETCO2 and TcCO2, both considering the mean nocturnal PCO2 (r = 0.897, p < 0.001; bias -1.1 [- 9.0; 6.9] mmHg) and the maximal PCO2 value over the night (r = 0.905, p < 0.001; bias 3.1 [-4.5; 10.8] mmHg). The concordance of the two techniques in detecting overnight PCO2 fluctuations was high, with r = 0.919 (p < 0.001) for the time spent with PCO2 >45 mmHg and r = 0.943 (p < 0.001) for the time with PCO2 >50 mmHg. CONCLUSIONS The ventilator-integrated end-tidal CO2 monitoring is as reliable as the currently used transcutaneous measurement, resulting to be a valuable proxy of the overnight PCO2 evolution. This result opens the possibility of a simplification in the monitoring of home ventilated patients, since ETCO2 measurement can be performed directly at home, with a low additional cost. However, the accuracy of both these measurement techniques is not sufficient to replace blood gases, which remain the reference examination. ClinicalTrials.gov registration:NCT02068911.
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Affiliation(s)
- David Orlikowski
- AP-HP, Hôpital Raymond Poincaré, Service de Réanimation médicale et unité de ventilation à domicile, 92380, Garches, France; AP-HP, Hôpital Raymond Poincaré, INSERM CIC 14.29, 92380, Garches, France
| | - Helene Prigent
- AP-HP, Hôpital Raymond Poincaré, Service de Physiologie-Explorations Fonctionnelles, 92380, Garches, France
| | - Xavier Ambrosi
- AP-HP, Hôpital Raymond Poincaré, Service de Réanimation médicale et unité de ventilation à domicile, 92380, Garches, France
| | - Isabelle Vaugier
- AP-HP, Hôpital Raymond Poincaré, INSERM CIC 14.29, 92380, Garches, France
| | - Sandra Pottier
- AP-HP, Hôpital Raymond Poincaré, INSERM CIC 14.29, 92380, Garches, France
| | - Djillali Annane
- AP-HP, Hôpital Raymond Poincaré, Service de Réanimation médicale et unité de ventilation à domicile, 92380, Garches, France
| | - Frederic Lofaso
- AP-HP, Hôpital Raymond Poincaré, Service de Physiologie-Explorations Fonctionnelles, 92380, Garches, France
| | - Adam Ogna
- AP-HP, Hôpital Raymond Poincaré, Service de Réanimation médicale et unité de ventilation à domicile, 92380, Garches, France; AP-HP, Hôpital Raymond Poincaré, INSERM CIC 14.29, 92380, Garches, France.
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Chiner E, Sancho-Chust JN, Landete P, Senent C, Gómez-Merino E. Complementary home mechanical ventilation techniques. SEPAR Year 2014. Arch Bronconeumol 2014; 50:546-53. [PMID: 25138799 DOI: 10.1016/j.arbres.2014.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 06/13/2014] [Accepted: 06/16/2014] [Indexed: 12/16/2022]
Abstract
This is a review of the different complementary techniques that are useful for optimizing home mechanical ventilation (HMV). Airway clearance is very important in patients with HMV and many patients, particularly those with reduced peak cough flow, require airway clearance (manual or assisted) or assisted cough techniques (manual or mechanical) and suctioning procedures, in addition to ventilation. In the case of invasive HMV, good tracheostomy cannula management is essential for success. HMV patients may have sleep disturbances that must be taken into account. Sleep studies including complete polysomnography or respiratory polygraphy are helpful for identifying patient-ventilator asynchrony. Other techniques, such as bronchoscopy or nutritional support, may be required in patients on HMV, particularly if percutaneous gastrostomy is required. Information on treatment efficacy can be obtained from HMV monitoring, using methods such as pulse oximetry, capnography or the internal programs of the ventilators themselves. Finally, the importance of the patient's subjective perception is reviewed, as this may potentially affect the success of the HMV.
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Affiliation(s)
- Eusebi Chiner
- Servicio de Neumología, Hospital Universitari Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, España.
| | - José N Sancho-Chust
- Servicio de Neumología, Hospital Universitari Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, España
| | - Pedro Landete
- Servicio de Neumología, Hospital Universitari Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, España
| | - Cristina Senent
- Servicio de Neumología, Hospital Universitari Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, España
| | - Elia Gómez-Merino
- Servicio de Neumología, Hospital Universitari Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, España
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Smith BK, Goddard M, Childers MK. Respiratory assessment in centronuclear myopathies. Muscle Nerve 2014; 50:315-26. [PMID: 24668768 DOI: 10.1002/mus.24249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 12/23/2022]
Abstract
The centronuclear myopathies (CNMs) are a group of inherited neuromuscular disorders classified as congenital myopathies. While several causative genes have been identified, some patients do not harbor any of the currently known mutations. These diverse disorders have common histological features, which include a high proportion of centrally nucleated muscle fibers, and clinical attributes of muscle weakness and respiratory insufficiency. Respiratory problems in CNMs may manifest initially during sleep, but daytime symptoms, ineffective airway clearance, and hypoventilation predominate as more severe respiratory muscle dysfunction evolves. Respiratory muscle capacity can be evaluated using a variety of clinical tests selected with consideration for the age and baseline motor function of the patient. Similar clinical tests of respiratory function can also be incorporated into preclinical CNM canine models to offer insight for clinical trials. Because respiratory problems account for significant morbidity in patients, routine assessments of respiratory muscle function are discussed.
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Affiliation(s)
- Barbara K Smith
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
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