Since Eve ate apples...

Rede Wageningen, 197

Non-invasive home mechanical ventilation: qualification, initiation, and monitoring

Following the introduction of non-invasive positive pressure ventilation (NPPV), the number of patients using home mechanical ventilation has increased substantially and continues to rise worldwide. This is primarily explained by both the effectiveness and comfort that are offered by NPPV in most patients, and particularly in patients with chest wall and neuromuscular diseases. For clinically stable patients the qualification for NPPV largely depends on the presence of complaints or signs of (nocturnal) hypoventilation with accompanying hypercapnia. For patients who are referred by an ICU there are additional prerequisites. In any case, the aims of NPPV should be met and NPPV should be effective. The initiation of NPPV, whether in the clinic or not, should always be tailored to the individual patient. Based on effectiveness, safety, and comfort, the best ventilator has to be chosen. Although with modern interfaces NPPV may be provided continuously, for continuing NPPV over the years, adding manual and/or mechanical cough augmentation techniques is usually mandatory. To control the ongoing effectiveness of NPPV regular monitoring of the patient is essential, and nowadays transcutaneous measurement of CO2 seems the most reliable and appropriate technique. For trend analysis, downloaded data of modern ventilators may be helpful as well. The ultimate goal of NPPV, to prevent tracheotomy, can only be reached if the patient has continuous access to a centre with expertise in cough augmentation techniques and both nocturnal and diurnal NPPV.Wprowadzenie nieinwazyjnej wentylacji mechanicznej (NWM) zwiększyło liczbę chorych korzystających z wentylacji mechanicznej w domu. Liczba ta stale rośnie na całym świecie. Jest to spowodowane przede wszystkim skutecznością i komfortem NWM u większości chorych, szczególnie u tych ze schorzeniami klatki piersiowej oraz chorobami nerwowo-mięśniowymi. U chorych stabilnych klinicznie kwalifikacja do NWM opiera się na dolegliwościach zgłaszanych w wywiadach i objawach nocnej hipowentylacji z towarzyszącą hiperkapnią. Pacjenci kierowani z oddziału intensywnej opieki medycznej muszą spełniać jeszcze inne kryteria. W każdym przypadku cele NWM powinny być spełnione i NWM powinna być skuteczna. Rozpoczęcie NWM zarówno w klinice, jak i poza nią musi być dostosowane do indywidualnych potrzeb pacjenta. W celu osiągnięcia skuteczności, bezpieczeństwa i komfortu należy wybrać najlepszy respirator. Dzięki wykorzystaniu nowoczesnej maski NWM może być stosowana w sposób ciągły przez lata, chociaż zazwyczaj wymaga wspomagania kaszlu (ręcznego lub mechanicznego). Aby ocenić skuteczność NWM, konieczne jest monitorowanie chorego. Obecnie przezskórny pomiar CO2 wydaje się najbardziej odpowiednią techniką. Podczas długotrwałych obserwacji uzyskane dane powinny być wprowadzone do pamięci respiratora. Ostateczny cel NWM, którym jest uniknięcie tracheotomii, może zostać osiągnięty, jeśli pacjent ma zapewniony stały dostęp do centrum, które ma doświadczenie w technikach wspomagania kaszlu oraz nocnej i dziennej NWM

Die Leute sagen immer...

Rede Landbouwhogeschoo

Advances in Ambulatory Oxygen workshop and Longterm Oxygen therapy in real-life practice.

The practical workshop presented recent advances in the field of ambulatory oxygen (AO), with experts discussing identification of patients who would benefit from AO, as well as current trials to measure specific benefits of AO in chronic patients. In particular, AO prescription in clinical practice and developments in pulsed-dose delivery of AO as a more efficient method of oxygen delivery were extensively discussed. After audience questions, the attendees had the opportunity to handle the AO systems on display in order to gain greater insight into their functionality and wearability, which should assist them in providing the most appropriate device for each patient. The symposium addressed considerations required when prescribing long-term oxygen therapy (LTOT). Dr Kampelmacher reviewed current indications for LTOT, emphasising the importance of accurate assessment of patients for LTOT, optimisation of oxygen dose, and patient education. Dr Vivodtzev discussed the evidence for LTOT in patients with exercise-induced desaturation, the role of portable oxygen concentrators, and the optimisation necessary to benefit from their use. The symposium concluded with a health economic study presented by Dr Little, demonstrating the cost benefits of a reform of the Scottish healthcare oxygen supply service

Attitudes and preferences of home mechanical ventilation users from four European countries: an ERS/ELF survey

Home mechanical ventilation is increasingly used by people with chronic respiratory failure. However, there are few reports on attitudes towards treatment. A web-based survey in eight languages was disseminated across 11 European countries to evaluate the perception of home mechanical ventilation provision in ventilator-assisted individuals and caregivers. Out of 787 responders from 11 European countries, 687 were patients and 100 were caregivers. 95% of patients and 94% of caregivers were from only 4 countries (Germany, the Netherlands, Italy, Spain). The majority of respondents were male and aged 46-65\u2005years. Obstructive lung diseases were proportionally more represented among respondent patients (46%), and neuromuscular diseases (65%) were more represented among patients of respondent caregivers. About 20% of respondent patients and caregivers were not sure of the modality of ventilation. Different interfaces were used, with a minority of respondents in all countries using invasive home mechanical ventilation by tracheostomy. These results may be useful for healthcare providers and policy makers to improve the quality of patients' daily lives

The frontotemporal syndrome of ALS is associated with poor survival

Thirty percent of ALS patients have a frontotemporal syndrome (FS), defined as behavioral changes or cognitive impairment. Despite previous studies, there are no firm conclusions on the effect of the FS on survival and the use of non-invasive ventilation (NIV) in ALS. We examined the effect of the FS on survival and the start and duration of NIV in ALS. Behavioral changes were defined as >22 points on the ALS-Frontotemporal-Dementia-Questionnaire or ≥3 points on ≥2 items of the Neuropsychiatric Inventory. Cognitive impairment was defined as below the fifth percentile on ≥2 tests of executive function, memory or language. Classic ALS was defined as ALS without the frontotemporal syndrome. We performed survival analyses from symptom ons

Adult domiciliary oxygen therapy. Position statement of the Thoracic Society of Australia and New Zealand

The document attached has been archived with permission from the editor of the Medical Journal of Australia (26 April 2007). An external link to the publisher’s copy is included.• Patients with chronic obstructive pulmonary disease and a stable daytime PaO2 of ≤55 mmHg (7.3kPa) live longer and have a better quality of life if provided with long-term continuous oxygen therapy. • It is reasonable to offer continuous oxygen therapy also to patients with other lung diseases that cause chronic hypoxaemia. • Indications for supplemental oxygen therapy during exercise (ambulatory oxygen therapy) and sleep (nocturnal oxygen therapy) are less clear.Christine F McDonald, Alan J Crockett and Iven H Youn