A pilot study of nurse-led, home monitoring for patients with chronic respiratory failure and with mechanical ventilation assistance

Abstract

We assessed the feasibility of telemedicine for home monitoring of 45 patients with chronic respiratory failure (CRF) discharged from hospital. The patients transmitted pulsed arterial saturation (pSat) data via a telephone modem to a receiving station where a nurse was available for a teleconsultation. A respiratory physician was also available. Scheduled and ad hoc appointments were conducted. Thirty-five patients were on home mechanical ventilation, 13 with invasive and 22 with non-invasive devices. The main diagnosis was chronic obstructive pulmonary disease (COPD). The follow-up period was 176 days (SD 69). In all, 376 calls for scheduled consultations were received and 83 ad hoc consultations were requested by the patients. The actions taken were: 55 therapy modifications, 19 hospitalizations in a respiratory department for decompensated CRF, three hospitalizations in an intensive care unit (ICU), 22 requests for further investigations, 25 contacts with the general practitioner (GP), 66 demands for respiratory consultations and 10 calls for the emergency department. The mean time recorded for the 459 calls was 16 min/patient/week. In 82% of calls, a pSat recording was received successfully. The nurse time required to train the users in the operation of the pSat instrument was high (mean time 30 min). However, the results showed that home monitoring was feasible, and useful for titration of oxygen, mechanical ventilation setting and stabilization of relapses.

Tele-assistance in chronic respiratory failure patients: a randomised clinical trial

“…The need to rationalise healthcare costs [15][16][17] has prompted the development of new technologies for home assistance [18]. The model of telemedicine has recently been tested in different studies [13,[19][20][21][22] with the major end-points assessing programme feasibility. However, controlled studies that evaluate the influence of this new technique on outcomes are lacking.…”

Tele-monitoring of ventilator-dependent patients: a European Respiratory Society Statement

“…The addition of long-term NIV to standard treatment improves survival in these patients when it is aimed to significantly reduce arterial carbon dioxide tension [13]. Daily variations in respiratory rate and percentage of respiratory cycles triggered by the patient might be able to predict the risk for acute COPD exacerbations [14] and tele-monitoring is feasible to modify therapy in these patients [15].…”

“…Some programmes used weekly [42] or 3-month [43] phone calls as "store and-forward necessity". VITACCA et al [14,18] proposed an interactive online system: continuous on-call service was available 24/7 and arterial oxygen saturation measured by pulse oximetry (SpO 2 ) was accessible for check-point analysis [14,18].…”

Can Non-invasive Ventilation Settings Predicts Functional and Survival Outcome in ALS Patients?

“…It was considered an effective ventilation whether patient presented fingertip pulse oximetry>96%, and heart rate between 60-80 bpm under NIV during the medical consultation, with further analyses of satisfactory parameters of nocturnal percutaneous pulse oximetry as aforementioned. [18,19]; and we recorded data of compliance and each ventilation settings changes throughout NIV use [20]. All samples were fully compliant to NIV.…”