Weaning from Mechanical Ventilation Followed at Home with the Aid of a Telemedicine Program

Abstract

We describe the use of telemedicine in support of weaning from invasive mechanical ventilation on a 63-year-old woman of at home by means of a telepneumology program (TPP). Under telephone assistance of a pulmonologist and a TPP nurse tutor, the pulsed arterial saturimetric (pSaT), heart rate (HR), breathing pattern tracing monitoring transmitted via a home telephone line and the aid of the caregiver, the patient was able to maintain diurnal spontaneous breathing after 24 spontaneous breathing trial (SBT) steps twice daily. The duration of each SBT period progressively increased starting from 30 minutes up to 8 hours. This case report shows that many patients at home on ventilators could possibly be weaned through the use of remote monitoring and call center response, with only family/caregivers on-site.

A Novel Simple Internet-Based System for Real Time Monitoring and Optimizing Home Mechanical Ventilation

“…To our knowledge, the only real-time application of telemedicine in the field of HMV has been limited to the monitoring of the ventilation signals (16,17). By contrast, the approach devised in this work adds the possibility of controlling the ventilator settings to optimize patient ventilation in real time according to the actual ventilation signals.…”

Tele-monitoring of ventilator-dependent patients: a European Respiratory Society Statement

“…We identified only one case report about weaning from mechanical ventilation of a patient at home, with the help of telephone assistance [18]. The patient was able to increase the time of spontaneous breathing.…”

“…Some programmes used weekly [42] or 3-month [43] phone calls as "store and-forward necessity". VITACCA et al [14,18] proposed an interactive online system: continuous on-call service was available 24/7 and arterial oxygen saturation measured by pulse oximetry (SpO 2 ) was accessible for check-point analysis [14,18].…”

Health technology assessment review: Remote monitoring of vital signs - current status and future challenges

“…A criticism of the eICU is that these benefits may only be apparent in an environment where there is a shortage in the number of intensivists to adequately provide an onsite 24/7 specialist-led service. Other descriptions of the use of telemonitoring in critical care include the provision of support for patients requiring mechanical ventilation at home [45], which has proved to be successful in the weaning of a patient from home mechanical ventilation without onsite specialist help [46]. Systems that monitor patients' physiological parameters during home hemodialysis also exist [47].…”