Sleep related respiratory events during non-invasive ventilation of patients with chronic hypoventilation

Aarrestad, Sigurd; Qvarfort, Magnus; Tollefsen, Elin; Kleiven, Anne Louise; Janssens, Jean–Paul; Skjønsberg, Ole Henning

doi:10.1183/1393003.congress-2017.pa1878

Cited by 5 publications

(12 citation statements)

References 20 publications

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“…In addition, some manufacturers have developed algorithms for automatic estimation of leaks and residual upper airway obstructions (UAO). Residual UAO is common in patients undergoing nocturnal NIV [125] and their lack of correction has been associated with increased mortality in amyotrophic lateral sclerosis patients [126]. UAO estimation by algorithms showed reasonable accuracy compared with polysomnography and manual scoring [127].…”

Section: Narrative Question 2: How Can Clinicians Monitor and Follow-mentioning

confidence: 98%

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

et al. 2019

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BackgroundWhile the role of acute non-invasive ventilation (NIV) has been shown to improve outcome in acute life-threatening hypercapnic respiratory failure in COPD, the evidence of clinical efficacy of long-term home NIV (LTH-NIV) for management of COPD is less. This document provides evidence-based recommendations for the clinical application of LTH-NIV in chronic hypercapnic COPD patients.Materials and methodsThe European Respiratory Society task force committee was composed of clinicians, methodologists and experts in the field of LTH-NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology. The GRADE Evidence to Decision framework was used to formulate recommendations. A number of topics were addressed under a narrative format which provides a useful context for clinicians and patients.ResultsThe task force committee delivered conditional recommendations for four actionable PICO (target population-intervention-comparator-outcome) questions, 1) suggesting for the use of LTH-NIV in stable hypercapnic COPD; 2) suggesting for the use of LTH-NIV in COPD patients following a COPD exacerbation requiring acute NIV 3) suggesting for the use of NIV settings targeting a reduction in carbon dioxide and 4) suggesting for using fixed pressure support as first choice ventilator mode.ConclusionsManaging hypercapnia may be an important intervention for improving the health outcome of COPD patients with chronic respiratory failure. The task force conditionally supports the application of LTH-NIV to improve health outcome by targeting a reduction in carbon dioxide in COPD patients with persistent hypercapnic respiratory failure. These recommendations should be applied in clinical practice by practitioners that routinely care for chronic hypercapnic COPD patients.

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Section: Narrative Question 2: How Can Clinicians Monitor and Follow-mentioning

confidence: 98%

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

et al. 2019

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“…Patients established on NIV frequently have upper airway obstruction or may develop it whilst on NIV. 18 To help clinicians diagnose residual apnoea events, manufacturers have included connectors for integrated overnight cardiorespiratory polygraphy given additional signals such as thoraco-abdominal belts.…”

Section: Niv Hardwarementioning

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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“…A recent pilot proof‐of‐concept clinical trial showed a trend towards greater improvements in daytime PaCO 2 , HRQoL and sleep quality when using simple gas exchange monitoring compared to advanced monitoring . Moreover, it was shown that the presence of PVA do not necessarily affect outcomes in patients with CHRF . Conversely, Adler et al .…”

Section: Practical Advice On Initiation and Follow‐up Of Hi‐nivmentioning

confidence: 99%

High‐intensity non‐invasive ventilation in stable hypercapnic COPD: Evidence of efficacy and practical advice

Leest

Duiverman

2018

Respirology

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Patients with end‐stage chronic obstructive pulmonary disease (COPD) frequently develop chronic hypercapnic respiratory failure (CHRF), with disabling symptoms and poor survival. The use of long‐term nocturnal non‐invasive ventilation (NIV) to treat CHRF in COPD has long been subject of debate due to conflicting evidence. However, since the introduction of high‐intensity NIV (HI‐NIV) in COPD, physiological and clinical benefits have been shown. HI‐NIV refers to specific ventilator settings used for NIV aimed at achieving normocapnia or the lowest partial arterial carbon dioxide pressure (PaCO2) values as possible. This review will provide an overview of existing evidence of the efficacy of HI‐NIV stable COPD patients with CHRF. Secondly, we will discuss hypotheses underlying NIV benefit in stable hypercapnic COPD, providing insight into better patient selection and hopefully more individually titrated HI‐NIV. Finally, we will provide practical advice on how to initiate and follow‐up patients on HI‐NIV, with special emphasis on monitoring that should be available during the initiation and follow‐up of HI‐NIV, and will discuss more extended monitoring techniques that could improve HI‐NIV treatment in the future.

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Sleep related respiratory events during non-invasive ventilation of patients with chronic hypoventilation

Cited by 5 publications

References 20 publications

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

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

High‐intensity non‐invasive ventilation in stable hypercapnic COPD: Evidence of efficacy and practical advice

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