Home mechanical ventilation (HMV): Setup and outcome in Europe

Patout, Maxime; Ramsay, Michelle; Mackie, Mike; Lhuillier, Elodie; Grey, Natalie; Arbane, Gill; Marino, Philip; Steir, Joerg; Cuvelier, A.; Muir, Jean-François; Murphy, Patrick B.; Hart, Nicholas

doi:10.1183/13993003.congress-2015.oa4780

Cited by 6 publications

(10 citation statements)

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“…However, the study was only powered at 80% to detect a relatively large treatment effect of 33%, and so, a true difference is difficult to exclude. Furthermore, similar to the study by Piper et al , relatively modest pressures were delivered (mean IPAP: 19 cm H 2 O, mean EPAP: 12 cm H 2 O) when compared to published clinical data . Interestingly, there was a suggestion that NIV was associated with a quicker improvement in arterial blood gases, which may be an important consideration for patients presenting following an episode of acute decompensated respiratory failure.…”

Section: Management Of Obesity‐related Respiratory Failuresupporting

confidence: 53%

“…Furthermore, similar to the study by Piper et al, relatively modest pressures were delivered (mean IPAP: 19 cm H 2 O, mean EPAP: 12 cm H 2 O) when compared to published clinical data. 51 Interestingly, there was a suggestion that NIV was associated with a quicker improvement in arterial blood gases, which may be an important consideration for patients presenting following an episode of acute decompensated respiratory failure. The largest study comparing NIV and CPAP enrolled 221 patients (71 NIV, 80 CPAP and 70 control) presenting with de novo OHS with severe OSA; none were recruited in the post-acute setting.…”

Section: Ohs With Significant Osamentioning

confidence: 99%

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Non‐invasive ventilation for obese patients with chronic respiratory failure: Are two pressures always better than one?

2019

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Obesity‐related respiratory failure is increasingly common but remains under‐diagnosed and under‐treated. There are several clinical phenotypes reported, including severe obstructive sleep apnoea (OSA), isolated nocturnal hypoventilation with or without severe OSA and OSA complicating chronic obstructive pulmonary disease (COPD). The presence of hypercapnic respiratory failure is associated with poor clinical outcomes in each of these groups. While weight loss is a core aim of management, this is often unachievable, and treatment of sleep‐disordered breathing with positive airway pressure (PAP) therapy is the mainstay of clinical practice. Although there are few long‐term clinical efficacy trials, the lack of equipoise would prevent the utilization of an untreated control group. The current data support the use of PAP therapy to improve respiratory failure and is associated with improvements in health‐related quality of life, reduced healthcare utilization and reduced mortality. Both continuous PAP (CPAP) and non‐invasive ventilation (NIV) appear safe and effective in patients with obesity‐related respiratory failure and OSA, with or without COPD, and the current evidence would not support a single therapy choice in all patients. There are no studies of CPAP in patients with isolated nocturnal hypoventilation, and NIV would be the current recommendation in this patient group. Whichever starting therapy is used, titration should be performed to correct sleep‐disordered breathing and reverse chronic respiratory failure, with consideration of step‐down of the treatment based on a clinical re‐evaluation. In contrast, failure to reach physiological and clinical treatment targets should lead to the consideration of treatment escalation.

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Section: Management Of Obesity‐related Respiratory Failuresupporting

confidence: 53%

Section: Ohs With Significant Osamentioning

confidence: 99%

Non‐invasive ventilation for obese patients with chronic respiratory failure: Are two pressures always better than one?

2019

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“…This interesting finding is in line with the recent report that the clinical outcome in end-stage patients with overlap syndrome is better than those with COPD alone. 31 Nevertheless, we note that pathophysiological change in patients with overlap syndrome of severe COPD and mild OSA might differ from those with mild COPD and severe OSA; in addition variation on this spectrum may differ between western patients in whom OSA is more driven by obesity and Asian patients (as studied here) in whom craniofacial morphometry may be more relevant.…”

Section: Discussionmentioning

confidence: 68%

Coexistence of OSA may compensate for sleep related reduction in neural respiratory drive in patients with COPD

Gan

Xiao

et al. 2016

Thorax

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BackgroundThe mechanisms underlying sleep-related hypoventilation in patients with coexisting COPD and obstructive sleep apnoea (OSA), an overlap syndrome, are incompletely understood. We compared neural respiratory drive expressed as diaphragm electromyogram (EMGdi) and ventilation during stage 2 sleep in patients with COPD alone and patients with overlap syndrome.MethodsEMGdi and airflow were recorded during full polysomnography in 14 healthy subjects, 14 patients with OSA and 39 consecutive patients with COPD. The ratio of tidal volume to EMGdi was measured to indirectly assess upper airway resistance.ResultsThirty-five patients with COPD, 12 healthy subjects and 14 patients with OSA completed the study. Of 35 patients with COPD, 19 had COPD alone (FEV1 38.5%±16.3%) whereas 16 had an overlap syndrome (FEV1 47.5±16.2%, AHI 20.5±14.1 events/hour). Ventilation (VE) was lower during stage 2 sleep than wakefulness in both patients with COPD alone (8.6±2.0 to 6.5±1.5 L/min, p<0.001) and those with overlap syndrome (8.3±2.0 to 6.1±1.8 L/min). Neural respiratory drive from wakefulness to sleep decreased significantly for patients with COPD alone (29.5±13.3% to 23.0±8.9% of maximal, p<0.01) but it changed little in those with overlap syndrome. The ratio of tidal volume to EMGdi was unchanged from wakefulness to sleep in patients with COPD alone and healthy subjects but was significantly reduced in patients with OSA or overlap syndrome (p<0.05).ConclusionsStage 2 sleep-related hypoventilation in COPD alone is due to reduction of neural respiratory drive, but in overlap syndrome it is due to increased upper airway resistance.

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“…In accordance with our finding, usage of HMV for >4hours/day was associated with better survival. [10] Compared to previous data, the proportion of patients with COPD and motor neurone disease using HMV has increased. [3] Our data suggest that HMV supports stable management of hypercapnic respiratory failure in patients with CWD or slowly progressive NMD, such as Duchenne muscular dystrophy, for many years, whereas time-to-death is only a few months in motor neurone disease despite the use of HMV.…”

Section: Clinical Significancementioning

confidence: 87%

Time-to-death in chronic respiratory failure on home mechanical ventilation: A cohort study

Schwarz

Mackie

Weston

et al. 2020

Respiratory Medicine

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Home mechanical ventilation (HMV): Setup and outcome in Europe

Cited by 6 publications

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Non‐invasive ventilation for obese patients with chronic respiratory failure: Are two pressures always better than one?

Non‐invasive ventilation for obese patients with chronic respiratory failure: Are two pressures always better than one?

Coexistence of OSA may compensate for sleep related reduction in neural respiratory drive in patients with COPD

Time-to-death in chronic respiratory failure on home mechanical ventilation: A cohort study

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