Defining successful non‐invasive ventilation initiation: Data from a real‐life cohort

Jolly, Grégoire; Razakamanantsoa, Léa; Fresnel, Emeline; Gharsallaoui, Zouhaier; Cuvelier, A.; Patout, Maxime

doi:10.1111/resp.14118

Cited by 18 publications

(12 citation statements)

References 33 publications

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“…The latter finding could also reflect a selection bias, where patients with pulmonary diseases were invited to follow up in NIV clinic since this reflects the professional interest of the pulmonologist more than a patient with cardiac failure. We also did not have data available for other outcomes such quality of life or sleep in the NIV cases, and these parameters could arguably be as important as survival in a group of mostly elderly patients 17. If hospital readmission can be interpreted loosely as a quality of life indicator, there may also be a trend for poorer outcomes in the cases.…”

Section: Discussionmentioning

confidence: 98%

“…We also did not have data available for other outcomes such quality of life or sleep in the NIV cases, and these parameters could arguably be as important as survival in a group of mostly elderly patients. 17 If hospital readmission can be interpreted loosely as a quality of life indicator, there may also be a trend for poorer outcomes in the cases. As above, clinical trials will be needed to answer these questions.…”

Section: Discussionmentioning

confidence: 99%

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Transitioning from hospital to home with non-invasive ventilation: who benefits? Results of a cohort study

et al. 2022

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BackgroundNon-invasive ventilation (NIV) is effective in a variety of acute respiratory illnesses in hospitalised patients. Home NIV is effective for stable patients with hypercapnia due to neuromuscular or chronic pulmonary disease. However, there are little data to guide which patients may benefit from NIV immediately following hospitalisation with hypercapnia.ObjectiveTo evaluate outcomes of patients with daytime hypercapnia at the end of an acute hospital admission.DesignRetrospective cohort study.ParticipantsEntry into the cohort was by querying the hospital electronic medical system for consultations regarding NIV after discharge. Cases received NIV and controls did not. We extracted data on demographics, ICD-9 diagnoses and medications coded at admission, blood gas measurements and dates of discharge, first readmission and death.InterventionNone.Main measurementTime from hospital discharge to mortality or readmission.Key resultsWe identified 585 cases and 53 controls who survived to discharge at the index admission. Cases and controls were broadly similar in age and Charlson Comorbidity Index. In the whole cohort, cases treated with home NIV were at increased risk of death compared with controls (HR 1.88 95% CI 1.17 to 3.03). In multivariate Cox regression for all-cause mortality, poor prognostic factors were increasing age (HR 1.03 per year, 95% CI 1.02 to 1.04), cardiac failure (HR 1.31, 95% CI 1.01 to 1.67) and failure to attend NIV follow-up (HR 2.33, 95% CI 1.33 to 4.10). In contrast, chronic respiratory disease was associated with improved prognosis (HR 0.77, 95% CI 0.61 to 0.97) as was sleep apnoea (HR 0.44, 95% CI 0.23 to 0.83). Cases did not have different time-to-readmission compared with controls (HR 1.42 95% CI 0.99 to 2.02).ConclusionTransitioning to home NIV after a hypercapnic hospitalisation may be useful in younger, co-operative patients with chronic respiratory disease. For older patients or those with cardiac failure, home NIV may not be beneficial and may potentially be harmful.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Transitioning from hospital to home with non-invasive ventilation: who benefits? Results of a cohort study

et al. 2022

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“…Second, we only tested two type of leak patterns, one continuous and one inspiratory only. It would have been relevant to evaluate a random anarchic pattern of unintentional leakage or expiratory leak only, as made by Sogo, Luján et al [ 33 , 34 , 35 , 36 ]. It is likely that the presence of unintentional random anarchic leakage patterns can impact the functioning of the machines even more, since the irregular character of the leakage flow is not well corrected by the algorithms.…”

Section: Discussionmentioning

confidence: 99%

Responses of Bilevel Ventilators to Unintentional Leak: A Bench Study

Lebret

Fresnel²,

Prouvez

et al. 2022

Healthcare

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Background: The impact of leaks has mainly been assessed in bench models using continuous leak patterns which did not reflect real-life leakage. We aimed to assess the impact of the pattern and intensity of unintentional leakage (UL) using several respiratory models. Methods: An active artificial lung (ASL 5000) was connected to three bilevel-ventilators set in pressure mode; the experiments were carried out with three lung mechanics (COPD, OHS and NMD) with and without upper airway obstruction. Triggering delay, work of breathing, pressure rise time, inspiratory pressure, tidal volume, cycling delay and the asynchrony index were measured at 0, 6, 24 and 36 L/min of UL. We generated continuous and inspiratory UL. Results: Compared to 0 L/min of UL, triggering delays were significantly higher with 36 L/min of UL (+27 ms) and pressure rise times were longer (+71 ms). Cycling delays increased from −4 [−250–169] ms to 150 [−173–207] ms at, respectively 0 L/min and 36 L/min of UL and work of breathing increased from 0.15 [0.12–0.29] J/L to 0.19 [0.16–0.36] J/L. Inspiratory leakage pattern significantly increased triggering delays (+35 ms) and cycling delays (+263 ms) but decreased delivered pressure (−0.94 cmH2O) compared to continuous leakage pattern. Simulated upper airway obstruction significantly increased triggering delay (+199 ms), cycling delays (+371 ms), and decreased tidal volume (−407 mL) and pressure rise times (−56 ms). Conclusions: The pattern of leakage impacted more the device performances than the magnitude of the leakage per se. Flow limitation negatively reduced all ventilator performances.

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“…Different ventilator modes may be used to achieve ventilatory control, which may theoretically influence adherence and sleep quality. When using fixed pressure support ventilation, obese patients require higher pressures to overcome upper airway obstruction and achieve adequate control of hypoventilation [ 21 ]. Volume-targeted pressure support ventilation is increasingly used in OHS.…”

Section: Chronic Respiratory Failure: Pathophysiology and Health Perc...mentioning

confidence: 99%

Quality of life in patients with chronic respiratory failure on home mechanical ventilation

et al. 2023

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Home mechanical ventilation (HMV) is a treatment for chronic respiratory failure that has shown clinical and cost effectiveness in patients with underlying COPD, obesity-related respiratory failure and neuromuscular disease (NMD). By treating chronic respiratory failure with adequate adherence to HMV, improvement in patient-reported outcomes including health-related quality of life (HRQoL) have been evaluated using general and disease-specific quantitative, semi-qualitative and qualitative methods. However, the treatment response in terms of trajectory of change in HRQoL is not uniform across the restrictive and obstructive disease groups. In this review, the effect of HMV on HRQoL across the domains of symptom perception, physical wellbeing, mental wellbeing, anxiety, depression, self-efficacy and sleep quality in stable and post-acute COPD, rapidly progressive NMD (such as amyotrophic lateral sclerosis), inherited NMD (including Duchenne muscular dystrophy) and obesity-related respiratory failure will be discussed.

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Defining successful non‐invasive ventilation initiation: Data from a real‐life cohort

Cited by 18 publications

References 33 publications

Transitioning from hospital to home with non-invasive ventilation: who benefits? Results of a cohort study

Transitioning from hospital to home with non-invasive ventilation: who benefits? Results of a cohort study

Responses of Bilevel Ventilators to Unintentional Leak: A Bench Study

Quality of life in patients with chronic respiratory failure on home mechanical ventilation

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