Using domiciliary non-invasive ventilator data downloads to inform clinical decision-making to optimise ventilation delivery and patient compliance

Abstract

IntroductionVentilation parameter data from patients receiving home mechanical ventilation can be collected via secure data cards and modem technology. This can then be reviewed by clinicians and ventilator prescriptions adjusted. Typically available measures include tidal volume (VT), leak, respiratory rate, minute ventilation, patient triggered breaths, achieved pressures and patient compliance. This study aimed to assess the potential impact of ventilator data downloads on management of patients requiring home non-invasive ventilation (NIV).MethodsA longitudinal within-group design with repeated measurements was used. Baseline ventilator data were downloaded, reviewed and adjustments made to optimise ventilation. Leak, VT and compliance data were collected for comparison at the first review and 3–7 weeks later. Ventilator data were monitored and amended remotely via a modem by a consultant physiotherapist between the first review and second appointment.ResultsAnalysis of data from 52 patients showed increased patient compliance (% days used >4 hours) from 90% to 96% (p=0.007), increased usage from 6.53 to 6.94 hours (p=0.211) and a change in VT(9.4 vs 8.7 mL/kg/ideal body weight, p=0.022). There was no change in leak following review of NIV prescriptions (mean (SD): 43 (23.4) L/min vs 45 (19.9)L/min, p=0.272).ConclusionVentilator data downloads, via early remote assessment, can help optimise patient ventilation through identification of modifiable factors, in particular interface leak and ventilator prescriptions. However, a prospective study is required to assess whether using ventilator data downloads provides value in terms of patient outcomes and cost-effectiveness. The presented data will help to inform the design of such a study.

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

“…Leaks are responsible for intolerance, nocturnal awakenings, poor compliance, patient–device asynchrony and suboptimal correction of nocturnal respiratory events. Thus, telemonitoring of leaks by the home ventilator software may be very useful and would allow rapid intervention at home should adjustments be required …”

“…To date, studies have mainly demonstrated its feasibility in different clinical situations such as initiation of NIV within the home, or to identify changes in clinical status. Most studies are single centre, with short‐term follow‐ups, relatively small sample sizes and driven by expert teams, which limit the representativeness of the results …”

“…Thus, telemonitoring of leaks by the home ventilator software may be very useful and would allow rapid intervention at home should adjustments be required. 34 Good compliance with NIV is essential to improve clinical outcomes and blood gases. [35][36][37] Telemonitoring of compliance from the home ventilator is reliable and clinically useful.…”

“…Most studies are single centre, with short-term follow-ups, relatively small sample sizes and driven by expert teams, which limit the representativeness of the results. 25,34 Several clinical trials investigating telemonitoring for NIV parameters are currently ongoing or have just been completed ( Table 2). The French Health Authority (DGOS: Direction Générale de l'Offre de Soins) is funding national evaluations of telemonitoring in four different diseases: (i) diabetes, (ii) renal failure, (iii) cardiac failure and (iv) chronic respiratory failure treated by home NIV.…”

Advances in non‐invasive positive airway pressure technology

“…Furthermore, different factors influenced the size of this difference depending on the brand of device used . Nevertheless, these data can improve the clinician's ability to recognize potential problems early and intervene . Incorporation of additional signals into the ventilator such as oximetry in conjunction with machine‐derived signals such as airflow and leak can provide valuable information to guide the optimization of therapy, with potentially significant clinical impact …”