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

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

doi:10.1016/j.rmed.2017.10.025

Cited by 17 publications

(19 citation statements)

References 36 publications

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“…Alternative non-invasive signals of inspiratory muscle effort such as parasternal EMG,6 although theoretically simpler and used in clinical studies, require expertise and have limitations, such as postural artefacts and potential contamination of signals by other chest muscles 5. Other signals of inspiratory effort, such as analysis of mandibular movements,7 have not been validated under NIV and require further testing.…”

Section: Discussionmentioning

confidence: 99%

Framework for patient-ventilator asynchrony during long-term non-invasive ventilation

Gonzalez-Bermejo

Janssens

Rabec

et al. 2019

Thorax

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Episodes of patient-ventilator asynchrony (PVA) occur during acute and chronic non-invasive positive pressure ventilation (NIV). In long-term NIV, description and quantification of PVA is not standardised, thus limiting assessment of its clinical impact. The present report provides a framework for a systematic analysis of polygraphic recordings of patients under NIV for the detection and classification of PVA validated by bench testing. The algorithm described uses two different time windows: rate asynchrony and intracycle asynchrony. This approach should facilitate further studies on prevalence and clinical impact of PVA in long-term NIV.

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Section: Discussionmentioning

confidence: 99%

Framework for patient-ventilator asynchrony during long-term non-invasive ventilation

Gonzalez-Bermejo

Janssens

Rabec

et al. 2019

Thorax

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“…Patients established on NIV frequently have upper airway obstruction or may develop it whilst on NIV . 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 Monitoring Systemsmentioning

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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“…The presence of residual respiratory events is frequent and has a documented impact on quality of sleep and sleep structure ( 23 , 57 – 60 ) ( Figures 3–5 ). Severe patient-ventilator asynchrony may compromise the efficacy of NIV.…”

Section: Introductionmentioning

confidence: 99%

Monitoring Long Term Noninvasive Ventilation: Benefits, Caveats and Perspectives

Janssens

Cantero

Pasquina³

et al. 2022

Front. Med.

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Long term noninvasive ventilation (LTNIV) is a recognized treatment for chronic hypercapnic respiratory failure (CHRF). COPD, obesity-hypoventilation syndrome, neuromuscular disorders, various restrictive disorders, and patients with sleep-disordered breathing are the major groups concerned. The purpose of this narrative review is to summarize current knowledge in the field of monitoring during home ventilation. LTNIV improves symptoms related to CHRF, diurnal and nocturnal blood gases, survival, and health-related quality of life. Initially, patients with LTNIV were most often followed through elective short in-hospital stays to ensure patient comfort, correction of daytime blood gases and nocturnal oxygenation, and control of nocturnal respiratory events. Because of the widespread use of LTNIV, elective in-hospital monitoring has become logistically problematic, time consuming, and costly. LTNIV devices presently have a built-in software which records compliance, leaks, tidal volume, minute ventilation, cycles triggered and cycled by the patient and provides detailed pressure and flow curves. Although the engineering behind this information is remarkable, the quality and reliability of certain signals may vary. Interpretation of the curves provided requires a certain level of training. Coupling ventilator software with nocturnal pulse oximetry or transcutaneous capnography performed at the patient's home can however provide important information and allow adjustments of ventilator settings thus potentially avoiding hospital admissions. Strategies have been described to combine different tools for optimal detection of an inefficient ventilation. Recent devices also allow adapting certain parameters at a distance (pressure support, expiratory positive airway pressure, back-up respiratory rate), thus allowing progressive changes in these settings for increased patient comfort and tolerance, and reducing the requirement for in-hospital titration. Because we live in a connected world, analyzing large groups of patients through treatment of “big data” will probably improve our knowledge of clinical pathways of our patients, and factors associated with treatment success or failure, adherence and efficacy. This approach provides a useful add-on to randomized controlled studies and allows generating hypotheses for better management of HMV.

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

Cited by 17 publications

References 36 publications

Framework for patient-ventilator asynchrony during long-term non-invasive ventilation

Framework for patient-ventilator asynchrony during long-term non-invasive ventilation

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

Monitoring Long Term Noninvasive Ventilation: Benefits, Caveats and Perspectives

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