Randomized cross‐over trial of ventilator modes during non‐invasive ventilation titration in amyotrophic lateral sclerosis

Vrijsen, Bart; Buyse, Bertien; Belge, Catharina; Vanpee, Goele; Damme, Philip Van; Testelmans, Dries

doi:10.1111/resp.13046

Cited by 24 publications

(27 citation statements)

References 35 publications

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“…29 Vrijsen et al found that residual nocturnal respiratory events under NIV were prevalent in patients with amyotrophic lateral sclerosis, justifying screening with polysomnography under NIV. 30 However, a single night in a sleep laboratory may be insufficient to fully correct nocturnal events. Moreover, access to in-lab may be limited by bed availability and cost.…”

Section: Connectivity Via External Plugin §mentioning

confidence: 99%

Technological advances in home non‐invasive ventilation monitoring: Reliability of data and effect on patient outcomes

2019

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Home non‐invasive mechanical ventilation (NIV) has become a well‐established treatment for patients with chronic hypercapnic respiratory failure. NIV monitoring has been developed to evaluate the effectiveness of mechanical ventilation on patient outcomes, with built‐in systems providing data on compliance, leaks and respiratory parameters. Although these data seem intuitively useful, two main concerns have been raised in the literature: (i) are they reliable and (ii) to what extent does their use improve patient outcomes. These two concerns are currently relevant since the very recent development of telemonitoring provides the possibility of adjusting ventilator settings remotely, based on the longitudinal assessment of NIV parameters and respiratory variables provided by the system. This may influence the future management strategies of health organizations for patients under home NIV. This narrative review describes technological advances in patient monitoring using home mechanical ventilation with a main focus on data provided by built‐in NIV monitoring systems. The use of these systems is discussed, including their advantages and limitations in different clinical situations, and perspectives for long‐term patient monitoring are discussed.

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Section: Connectivity Via External Plugin §mentioning

confidence: 99%

Technological advances in home non‐invasive ventilation monitoring: Reliability of data and effect on patient outcomes

2019

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“…Low‐level inspiratory pressure support is generally sufficient when initiating NIV. Semi‐controlled pressure modes (spontaneous modes with back‐up frequency) are preferred, being more effective in ALS than spontaneous modes . Ventilator settings can then be adjusted to ensure sufficient inspiratory assistance to obtain normal daytime and nocturnal PaCO 2 .…”

Section: How Should Als Patients Be Ventilated?mentioning

confidence: 99%

“…Pressure assist‐control ventilation does not need to be changed to volume assist‐control ventilation in ventilator‐dependent patients. A semi‐controlled mode with back‐up rate is sufficient, even in 24‐h‐a‐day ventilator‐dependent patients. The security of ventilation, the presence of alarms and batteries, the dimensions, simplicity (or complexity) and noise are not better, at the present time, with either pressure assist‐control or volume assist‐control ventilators.…”

Section: How Should Als Patients Be Ventilated?mentioning

confidence: 99%

NIV in amyotrophic lateral sclerosis: The ‘when’ and ‘how’ of the matter

2019

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Non-invasive ventilation (NIV) has become an essential part of the treatment of amyotrophic lateral sclerosis (ALS) since 2006. NIV very significantly improves survival, quality of life and cognitive performances. The initial NIV settings are simple, but progression of the disease, ventilator dependence and upper airway involvement sometimes make long-term adjustment of NIV more difficult, with a major impact on survival. Unique data concerning the long-term adjustment of NIV in ALS show that correction of leaks, management of obstructive apnoea and adaptation to the patient's degree of ventilator dependence improve the prognosis. Non-ventilatory factors also impact the efficacy of NIV and various solutions have been described and must be applied, including cough assist techniques, control of excess salivation and renutrition. NIV in ALS has been considerably improved as a result of application of all of these measures, avoiding the need for tracheostomy in the very great majority of cases. More advanced use of NIV also requires pulmonologists to master the associated end-of-life palliative care, as well as the modalities of discontinuing ventilation when it becomes unreasonable. Respirology (2019) 24, 521-530 522 C Morelot-Panzini et al. ALS, amyotrophic lateral sclerosis; EPAP, expiratory positive airway pressure; I/E ratio, inspiratory time/expiratory time ratio; NIV, non-invasive ventilation; RR, respiratory rate; Ti, inspiratory time.Respirology (2019) 24, 521-530

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“…While venous bicarbonate sampling may be used to screen for sleep hypoventilation particularly for obesity hypoventilation syndrome, raised levels may also reflect multimorbidity in this population . As shown by O’Donoghue et al, the development of awake hypercapnia and sleepiness in patients with myotonic dystrophy is not necessarily a consequence simply of sleep‐disordered breathing, raising issues of disease‐specific guidelines for NIV timing, modes of ventilation and expected outcomes . Mask fitting is critical in minimizing complications and improving NIV efficacy.…”

Section: Sleepmentioning

confidence: 99%

Year in review 2017: Interstitial lung disease, pulmonary vascular disease and sleep

et al. 2018

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Randomized cross‐over trial of ventilator modes during non‐invasive ventilation titration in amyotrophic lateral sclerosis

Abstract: ST mode shows better results in gas exchange, respiratory events and PVA. Nevertheless, accurate NIV titration remains necessary as some patients show equal or better results when using the S mode.

Cited by 24 publications

References 35 publications

Technological advances in home non‐invasive ventilation monitoring: Reliability of data and effect on patient outcomes

Technological advances in home non‐invasive ventilation monitoring: Reliability of data and effect on patient outcomes

NIV in amyotrophic lateral sclerosis: The ‘when’ and ‘how’ of the matter

Year in review 2017: Interstitial lung disease, pulmonary vascular disease and sleep

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