"Tricks and tips for home mechanical ventilation" Home mechanical ventilation:set-up and monitoring protocols

In this part of the review series "Tricks and tips for home mechanical ventilation", we will discuss the evidence with regard to the place and manner of home mechanical ventilation initiation and follow-up. Outsourcing more and more of this chronic care to the home situation is a big challenge for the future: especially for the home situation, monitoring has to be non-invasive, reliable and easy to use, data security needs to be ensured, signals need to be integrated and preferably automatically processed and algorithms need to be developed based on clinically relevant outcomes

Effects of non-invasive positive pressure ventilation (NIPPV) in stable chronic obstructive pulmonary disease (COPD)

This review provides an overview of the randomised controlled trials covering the topic of chronic non-invasive positive pressure ventilation (NIPPV) in severe stable COPD patients. Studies investigating patients receiving bilevel NIPPV via nasal, oronasal or total face mask interfaces for at least 1 week or more, were described. Eight RCTs were included, from which six trials used NIPPV for up to 3 months (short-term) and two trials also obtained long-term effects (3 months to ≥2 years). Outcome parameters were: arterial blood gases, pulmonary function, respiratory mechanics, respiratory muscle strength, dyspnoea, exercise tolerance, health-related quality of life, neuropsychologic function, sleep quality, hospital admissions and survival. We found that NIPPV in addition to standard care can have beneficial effects on certain outcome measures, however results are conflicting. Therefore, evidence is insufficient to recommend NIPPV routinely in stable but severe COPD patients. Nevertheless, it seems that hypercapnic patients, who receive enough time to adjust to the ventilator and so obtain improved ventilation, could benefit from NIPPV

The effect of stepping down combination therapy on airway hyperresponsiveness to mannitol

SummaryRationaleControversy exists about the safety of long acting beta2-agonist (LABA) treatment, in particular in children. Combination therapy with a LABA and an inhaled corticosteroid (ICS) is prescribed to children with moderate asthma and can be stepped down by withdrawal of the LABA when asthma is well controlled.ObjectiveTo analyze the effect of stepping down from LABA/ICS combination therapy to monotherapy with the same dose of ICS on the airway response to mannitol in asthmatic children.Methods17 children, aged 12–17 years, with clinically stable asthma, receiving combination therapy, were analyzed in this observational prospective open-label study. Children performed a mannitol challenge at baseline and 30±4 days after their medication was stepped down to ICS monotherapy. The changes in the provoking dose of mannitol to cause a 15% fall in FEV1 (PD15), response-dose ratio and recovery time following a short acting beta2-agonist to ≥95% of baseline FEV1 were assessed.ResultsMannitol PD15 and response-dose ratio did not significantly change after stepping down. The recovery time following a short acting beta2-agonist to ≥95% of baseline FEV1 was significantly shorter (p=0.01) after the withdrawal of the LABA.ConclusionsIn short-term follow-up, stepping down clinically stable asthmatic children from combination therapy to monotherapy with an ICS does not change airway hyperresponsiveness (AHR) to mannitol but does shorten recovery time to baseline lung function following a rescue short acting beta2-agonist

Home oxygen therapy; indications are still limited

Prescription of long term oxygen treatment ( LTOT),based on old studies, is only indicated if there is severe hypoxaemia at rest (PaO2 &lt; 8,0 kPa) and should be used atleast 15 hours per day.However as newer treatments like nocturnal non-invasive ventilatory support showed to be beneficial, LTOT stands not on its own but should be part of a multidimensional approach in individual patients with COPD.</p

Home oxygen therapy; indications are still limited

Prescription of long term oxygen treatment ( LTOT),based on old studies, is only indicated if there is severe hypoxaemia at rest (PaO2 &lt; 8,0 kPa) and should be used atleast 15 hours per day.However as newer treatments like nocturnal non-invasive ventilatory support showed to be beneficial, LTOT stands not on its own but should be part of a multidimensional approach in individual patients with COPD.</p