Duiverman, Marieke L.

Heunks, Leo

European Respiratory Review

English

University of Groningen

University of GroningenNew insights into acute and chronic respiratory failureHeunks, Leo; Duiverman, Marieke L.Published in:European Respiratory ReviewDOI:10.1183/16000617.0027-2023IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2023Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Heunks, L., & Duiverman, M. L. (2023). New insights into acute and chronic respiratory failure: highlightsfrom the Respiratory Failure and Mechanical Ventilation Conference 2022. European Respiratory Review,32(168), Article 230027. https://doi.org/10.1183/16000617.0027-2023CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 28-12-2025New insights into acute and chronic respiratory failure:highlights from the Respiratory Failure and MechanicalVentilation Conference 2022Leo Heunks1 and Marieke L. Duiverman 21Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. 2Department of PulmonaryDiseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Corresponding author: Leo Heunks (l.heunks@erasmusmc.nl)Shareable abstract (@ERSpublications)Highlights from the Respiratory Failure and Mechanical Ventilation Conference 2022 https://bit.ly/3HMWKTpCite this article as: Heunks L, Duiverman ML. New insights into acute and chronic respiratory failure:highlights from the Respiratory Failure and Mechanical Ventilation Conference 2022. Eur Respir Rev2023; 32: 230027 [DOI: 10.1183/16000617.0027-2023].The European Respiratory Society (ERS) is home to clinicians, scientists and students interested inrespiratory medicine. In June 2022, the Society organised the second edition of the “Respiratory Failureand Mechanical Ventilation Conference”. This event focuses on clinical and scientific aspects of acute andchronic respiratory failure. Faculty and participants from 50 countries around the globe met in Berlin,although this time most of the sessions could also be accessed online. Participants with very diversebackgrounds, including medicine, nursing, physiotherapy and industry, discussed all aspects of respiratoryfailure including physiology, interventions for respiratory support, advanced diagnostic techniques, qualityof life, and end of life care. Our common ground was passion for respiratory failure. The quality of thesessions during this 3-day conference was outstanding, and many of the presentations are still available forconference participants through the ERS website. However, the conference organisers felt that many of thetopics discussed deserved an even broader audience. We are happy that the editors of the EuropeanRespiratory Review have invited selected speakers to write a review based on the topic of their presentationduring the “Respiratory Failure and Mechanical Ventilation Conference”. The response has been fantastic,and the manuscripts provide an excellent overview of the topics covered during the conference andhighlight developments in the field of respiratory medicine. All the papers in this series are worth readingin detail, and we wish to highlight a few of them in this editorial.Advanced physiological respiratory monitoring is an attractive approach to individualise mechanicalventilation. Traditionally, clinicians rely on airway pressures measured by the ventilator during therespiratory cycle. In the absence of air flow (inspiratory or expiratory hold manoeuvre) the pressure in theventilator equals alveolar pressure (in the absence of airway collapse). However, from a physiologicalperspective, it is not the alveolar pressure that predicts alveolar injury. Distension of the alveolus, leadingto alveolar injury, is better reflected by the difference in alveolar and pleural pressure. The oesophagealpressure provides an estimation of pleural pressure and as reviewed by JONKMAN et al. [1] in a forthcomingarticle in this series, may help to deliver lung and diaphragm protective mechanical ventilation [2].Although we are waiting for clinical studies to provide evidence that oesophageal pressure monitoringimproves clinical outcome, a strong physiological rationale exists for this relatively simple and cheapmonitoring technique.Initiation of weaning is an important milestone for patients on invasive mechanical ventilation. Delayedweaning is associated with adverse clinical outcome [3]. The pathophysiology of difficult weaning iscomplex, and many reasons have been identified for difficult ventilator weaning [4]. In the current series,BUREAU et al. [5] discuss the pathophysiology of critical illness-associated respiratory muscle weakness andinterventions that may help to improve respiratory muscle strength and ultimately weaning outcome. BothCopyright ©The authors 2023This version is distributed underthe terms of the CreativeCommons Attribution Non-Commercial Licence 4.0. Forcommercial reproduction rightsand permissions contactpermissions@ersnet.orgReceived: 5 Feb 2023Accepted: 7 Feb 2023https://doi.org/10.1183/16000617.0027-2023 Eur Respir Rev 2023; 32: 230027EUROPEAN RESPIRATORY REVIEWEDITORIALL. HEUNKS AND M. DUIVERMANprevention of respiratory muscle weakness (diaphragm protective mechanical ventilation) and interventionsthat aim to improve strength are discussed in detail and are important for clinicians caring for weaningfailure patients.In patients with chronic respiratory failure, improvement of quality of life should be an important goalwhen starting home mechanical ventilation (HMV). This topic is discussed extensively in a forthcomingarticle by D’CRUZ et al. [6] entitled “Quality of life in patients with chronic respiratory failure on homemechanical ventilation”. Multiple factors, like the underlying cause of respiratory failure, disease severityat presentation, trajectory of respiratory failure progression, clinical response to HMV, the impact of thetreatment on the patient’s autonomy and caregiver wellbeing, patient’s preferences, values and beliefs, andsocial/environmental circumstances influence health perception in patients on HMV. The authorssummarise well-known health-related quality of life questionnaires developed for patients with respiratoryfailure [7], although they do recognise that more quantitative interviews might be needed to capture allthese elements. The challenge is to acknowledge all these factors and discuss them when decisions aboutmedical interventions need to be taken.In the review entitled “The role of telemonitoring in patients on home mechanical ventilation” [8], weaimed to discuss this upcoming way of working by reviewing studies on this topic and by placing theliterature in the context of daily practice and future perspectives. Initiation of chronic noninvasiveventilation at home is a cost-effective alternative to standard in-hospital initiation, and is, above all,preferred by patients who are severely disabled by their disease [9, 10]. Telemonitoring is already used inthe follow-up of patients on HMV but the methods of monitoring are diverse, and controlled studiescomparing this way of working with standard care are limited. A challenge for the coming years will be toprovide evidence-based guidance on how to effectively incorporate rapidly evolving e-heath technology inthe daily practice of HMV set-up and follow-up [11].We are confident that this series of papers will be of interest to clinicians and scientists interested inrespiratory failure and mechanical ventilation. If so, we hope to welcome you at the 2024 edition of theERS Respiratory Failure and Mechanical ventilation Conference! #RFMV2024.Provenance: Commissioned article, peer reviewed.Conflict of interest: L. Heunks has received grants or contracts from ZonMW (Dutch government), for clinicalresearch; consulting fees from Liberate Medical; payment or honoraria from American Thoracic Society; andreports leadership or fiduciary role as an Associate editor for the American Journal of Respiratory and Critical CareMedicine, and committees for ESICM and FERS, outside the submitted work. M.L. Duiverman has received researchgrants from RESMED, Philips, Lowenstein, Vivisol, Sencure, and Fisher&Paykel; and speaker fees from Chiesi andBreas, outside the submitted work.References1 Jonkman AH, Telias I, Spinelli E, et al. The oesophageal balloon for respiratory monitoring in ventilatedpatients: updated clinical review and practical aspects. Eur Respir Rev 2023; in press [https://doi.org/10.1183/16000617.0186-2022].2 Goligher EC, Jonkman AH, Dianti J, et al. Clinical strategies for implementing lung and diaphragm-protectiveventilation: avoiding insufficient and excessive effort. Intensive Care Med 2020; 46: 2314–2326.3 Pham T, Heunks L, Bellani G, et al. Weaning from mechanical ventilation in intensive care units across 50countries (WEAN SAFE): a multicentre, prospective, observational cohort study. Lancet Respir Med 2023; inpress [https://doi.org/10.1016/S2213-2600(22)00449-0].4 Heunks LM, van der Hoeven JG. Clinical review: the ABC of weaning failure--a structured approach. Crit Care2010; 14: 245.5 Bureau C, Van Hollebeke M, Dres M. Managing respiratory muscle weakness during weaning from invasiveventilation. Eur Respir Rev 2023; 32: 220205.6 D’Cruz RF, Kaltsakas K, Suh E-S, et al. Quality of life in patients with chronic respiratory failure on homemechanical ventilation. Eur Respir Rev 2023; in press [https://doi.org/10.1183/16000617.0237-2022].7 Struik FM, Kerstjens HA, Bladder G, et al. The Severe Respiratory Insufficiency Questionnaire scored best inthe assessment of health-related quality of life in chronic obstructive pulmonary disease. J Clin Epidemiol2013; 66: 1166–1174.8 van den Biggelaar R, Hazenberg A, Duiverman ML. The role of telemonitoring in patients on homemechanical ventilation. Eur Respir Rev 2023; 32: 220207.https://doi.org/10.1183/16000617.0027-2023 2EUROPEAN RESPIRATORY REVIEW RFMV CONFERENCE REVIEWS | L. HEUNKS AND M. DUIVERMAN9 Duiverman ML, Vonk JM, Bladder G, et al. Home initiation of chronic non-invasive ventilation in COPDpatients with chronic hypercapnic respiratory failure: a randomised controlled trial. Thorax 2020; 75: 244–252.10 van den Biggelaar RJM, Hazenberg A, Cobben NAM, et al. A randomized trial of initiation of chronicnoninvasive mechanical ventilation at home vs in-hospital in patients with neuromuscular disease andthoracic cage disorder: the dutch homerun trial. Chest 2020; 158: 2493–2501.11 Ambrosino N, Pierucci P. Using telemedicine to monitor the patient with chronic respiratory failure. Life(Basel) 2021; 11: 1113.https://doi.org/10.1183/16000617.0027-2023 3EUROPEAN RESPIRATORY REVIEW RFMV CONFERENCE REVIEWS | L. HEUNKS AND M. DUIVERMAN

New insights into acute and chronic respiratory failure:highlights from the Respiratory Failure and Mechanical Ventilation Conference 2022

ARTS repository - University of Groningen

   University of GroningenNew insights into acute and chronic respiratory failureHeunks, Leo; Duiverman, Marieke L.Published in:European Respiratory ReviewDOI:10.1183/16000617.0027-2023IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2023Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Heunks, L., & Duiverman, M. L. (2023). New insights into acute and chronic respiratory failure: highlightsfrom the Respiratory Failure and Mechanical Ventilation Conference 2022. European Respiratory Review,32(168), Article 230027. https://doi.org/10.1183/16000617.0027-2023CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 11-09-2023New insights into acute and chronic respiratory failure:highlights from the Respiratory Failure and MechanicalVentilation Conference 2022Leo Heunks1 and Marieke L. Duiverman 21Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. 2Department of PulmonaryDiseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Corresponding author: Leo Heunks (l.heunks@erasmusmc.nl)Shareable abstract (@ERSpublications)Highlights from the Respiratory Failure and Mechanical Ventilation Conference 2022 https://bit.ly/3HMWKTpCite this article as: Heunks L, Duiverman ML. New insights into acute and chronic respiratory failure:highlights from the Respiratory Failure and Mechanical Ventilation Conference 2022. Eur Respir Rev2023; 32: 230027 [DOI: 10.1183/16000617.0027-2023].The European Respiratory Society (ERS) is home to clinicians, scientists and students interested inrespiratory medicine. In June 2022, the Society organised the second edition of the “Respiratory Failureand Mechanical Ventilation Conference”. This event focuses on clinical and scientific aspects of acute andchronic respiratory failure. Faculty and participants from 50 countries around the globe met in Berlin,although this time most of the sessions could also be accessed online. Participants with very diversebackgrounds, including medicine, nursing, physiotherapy and industry, discussed all aspects of respiratoryfailure including physiology, interventions for respiratory support, advanced diagnostic techniques, qualityof life, and end of life care. Our common ground was passion for respiratory failure. The quality of thesessions during this 3-day conference was outstanding, and many of the presentations are still available forconference participants through the ERS website. However, the conference organisers felt that many of thetopics discussed deserved an even broader audience. We are happy that the editors of the EuropeanRespiratory Review have invited selected speakers to write a review based on the topic of their presentationduring the “Respiratory Failure and Mechanical Ventilation Conference”. The response has been fantastic,and the manuscripts provide an excellent overview of the topics covered during the conference andhighlight developments in the field of respiratory medicine. All the papers in this series are worth readingin detail, and we wish to highlight a few of them in this editorial.Advanced physiological respiratory monitoring is an attractive approach to individualise mechanicalventilation. Traditionally, clinicians rely on airway pressures measured by the ventilator during therespiratory cycle. In the absence of air flow (inspiratory or expiratory hold manoeuvre) the pressure in theventilator equals alveolar pressure (in the absence of airway collapse). However, from a physiologicalperspective, it is not the alveolar pressure that predicts alveolar injury. Distension of the alveolus, leadingto alveolar injury, is better reflected by the difference in alveolar and pleural pressure. The oesophagealpressure provides an estimation of pleural pressure and as reviewed by JONKMAN et al. [1] in a forthcomingarticle in this series, may help to deliver lung and diaphragm protective mechanical ventilation [2].Although we are waiting for clinical studies to provide evidence that oesophageal pressure monitoringimproves clinical outcome, a strong physiological rationale exists for this relatively simple and cheapmonitoring technique.Initiation of weaning is an important milestone for patients on invasive mechanical ventilation. Delayedweaning is associated with adverse clinical outcome [3]. The pathophysiology of difficult weaning iscomplex, and many reasons have been identified for difficult ventilator weaning [4]. In the current series,BUREAU et al. [5] discuss the pathophysiology of critical illness-associated respiratory muscle weakness andinterventions that may help to improve respiratory muscle strength and ultimately weaning outcome. BothCopyright ©The authors 2023This version is distributed underthe terms of the CreativeCommons Attribution Non-Commercial Licence 4.0. Forcommercial reproduction rightsand permissions contactpermissions@ersnet.orgReceived: 5 Feb 2023Accepted: 7 Feb 2023https://doi.org/10.1183/16000617.0027-2023 Eur Respir Rev 2023; 32: 230027EUROPEAN RESPIRATORY REVIEWEDITORIALL. HEUNKS AND M. DUIVERMANprevention of respiratory muscle weakness (diaphragm protective mechanical ventilation) and interventionsthat aim to improve strength are discussed in detail and are important for clinicians caring for weaningfailure patients.In patients with chronic respiratory failure, improvement of quality of life should be an important goalwhen starting home mechanical ventilation (HMV). This topic is discussed extensively in a forthcomingarticle by D’CRUZ et al. [6] entitled “Quality of life in patients with chronic respiratory failure on homemechanical ventilation”. Multiple factors, like the underlying cause of respiratory failure, disease severityat presentation, trajectory of respiratory failure progression, clinical response to HMV, the impact of thetreatment on the patient’s autonomy and caregiver wellbeing, patient’s preferences, values and beliefs, andsocial/environmental circumstances influence health perception in patients on HMV. The authorssummarise well-known health-related quality of life questionnaires developed for patients with respiratoryfailure [7], although they do recognise that more quantitative interviews might be needed to capture allthese elements. The challenge is to acknowledge all these factors and discuss them when decisions aboutmedical interventions need to be taken.In the review entitled “The role of telemonitoring in patients on home mechanical ventilation” [8], weaimed to discuss this upcoming way of working by reviewing studies on this topic and by placing theliterature in the context of daily practice and future perspectives. Initiation of chronic noninvasiveventilation at home is a cost-effective alternative to standard in-hospital initiation, and is, above all,preferred by patients who are severely disabled by their disease [9, 10]. Telemonitoring is already used inthe follow-up of patients on HMV but the methods of monitoring are diverse, and controlled studiescomparing this way of working with standard care are limited. A challenge for the coming years will be toprovide evidence-based guidance on how to effectively incorporate rapidly evolving e-heath technology inthe daily practice of HMV set-up and follow-up [11].We are confident that this series of papers will be of interest to clinicians and scientists interested inrespiratory failure and mechanical ventilation. If so, we hope to welcome you at the 2024 edition of theERS Respiratory Failure and Mechanical ventilation Conference! #RFMV2024.Provenance: Commissioned article, peer reviewed.Conflict of interest: L. Heunks has received grants or contracts from ZonMW (Dutch government), for clinicalresearch; consulting fees from Liberate Medical; payment or honoraria from American Thoracic Society; andreports leadership or fiduciary role as an Associate editor for the American Journal of Respiratory and Critical CareMedicine, and committees for ESICM and FERS, outside the submitted work. M.L. Duiverman has received researchgrants from RESMED, Philips, Lowenstein, Vivisol, Sencure, and Fisher&Paykel; and speaker fees from Chiesi andBreas, outside the submitted work.References1 Jonkman AH, Telias I, Spinelli E, et al. The oesophageal balloon for respiratory monitoring in ventilatedpatients: updated clinical review and practical aspects. Eur Respir Rev 2023; in press [https://doi.org/10.1183/16000617.0186-2022].2 Goligher EC, Jonkman AH, Dianti J, et al. Clinical strategies for implementing lung and diaphragm-protectiveventilation: avoiding insufficient and excessive effort. Intensive Care Med 2020; 46: 2314–2326.3 Pham T, Heunks L, Bellani G, et al. Weaning from mechanical ventilation in intensive care units across 50countries (WEAN SAFE): a multicentre, prospective, observational cohort study. Lancet Respir Med 2023; inpress [https://doi.org/10.1016/S2213-2600(22)00449-0].4 Heunks LM, van der Hoeven JG. Clinical review: the ABC of weaning failure--a structured approach. Crit Care2010; 14: 245.5 Bureau C, Van Hollebeke M, Dres M. Managing respiratory muscle weakness during weaning from invasiveventilation. Eur Respir Rev 2023; 32: 220205.6 D’Cruz RF, Kaltsakas K, Suh E-S, et al. Quality of life in patients with chronic respiratory failure on homemechanical ventilation. Eur Respir Rev 2023; in press [https://doi.org/10.1183/16000617.0237-2022].7 Struik FM, Kerstjens HA, Bladder G, et al. The Severe Respiratory Insufficiency Questionnaire scored best inthe assessment of health-related quality of life in chronic obstructive pulmonary disease. J Clin Epidemiol2013; 66: 1166–1174.8 van den Biggelaar R, Hazenberg A, Duiverman ML. The role of telemonitoring in patients on homemechanical ventilation. Eur Respir Rev 2023; 32: 220207.https://doi.org/10.1183/16000617.0027-2023 2EUROPEAN RESPIRATORY REVIEW RFMV CONFERENCE REVIEWS | L. HEUNKS AND M. DUIVERMAN9 Duiverman ML, Vonk JM, Bladder G, et al. Home initiation of chronic non-invasive ventilation in COPDpatients with chronic hypercapnic respiratory failure: a randomised controlled trial. Thorax 2020; 75: 244–252.10 van den Biggelaar RJM, Hazenberg A, Cobben NAM, et al. A randomized trial of initiation of chronicnoninvasive mechanical ventilation at home vs in-hospital in patients with neuromuscular disease andthoracic cage disorder: the dutch homerun trial. Chest 2020; 158: 2493–2501.11 Ambrosino N, Pierucci P. Using telemedicine to monitor the patient with chronic respiratory failure. Life(Basel) 2021; 11: 1113.https://doi.org/10.1183/16000617.0027-2023 3EUROPEAN RESPIRATORY REVIEW RFMV CONFERENCE REVIEWS | L. HEUNKS AND M. DUIVERMAN

Leo Heunks

Marieke L. Duiverman

Directory of Open Access Journals

New insights into acute and chronic respiratory failure: highlights from the Respiratory Failure and Mechanical Ventilation Conference 2022

   University of GroningenNew insights into acute and chronic respiratory failureHeunks, Leo; Duiverman, Marieke L.Published in:European Respiratory ReviewDOI:10.1183/16000617.0027-2023IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2023Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Heunks, L., & Duiverman, M. L. (2023). New insights into acute and chronic respiratory failure: highlightsfrom the Respiratory Failure and Mechanical Ventilation Conference 2022. European Respiratory Review,32(168), Article 230027. https://doi.org/10.1183/16000617.0027-2023CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 05-12-2023New insights into acute and chronic respiratory failure:highlights from the Respiratory Failure and MechanicalVentilation Conference 2022Leo Heunks1 and Marieke L. Duiverman 21Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. 2Department of PulmonaryDiseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Corresponding author: Leo Heunks (l.heunks@erasmusmc.nl)Shareable abstract (@ERSpublications)Highlights from the Respiratory Failure and Mechanical Ventilation Conference 2022 https://bit.ly/3HMWKTpCite this article as: Heunks L, Duiverman ML. New insights into acute and chronic respiratory failure:highlights from the Respiratory Failure and Mechanical Ventilation Conference 2022. Eur Respir Rev2023; 32: 230027 [DOI: 10.1183/16000617.0027-2023].The European Respiratory Society (ERS) is home to clinicians, scientists and students interested inrespiratory medicine. In June 2022, the Society organised the second edition of the “Respiratory Failureand Mechanical Ventilation Conference”. This event focuses on clinical and scientific aspects of acute andchronic respiratory failure. Faculty and participants from 50 countries around the globe met in Berlin,although this time most of the sessions could also be accessed online. Participants with very diversebackgrounds, including medicine, nursing, physiotherapy and industry, discussed all aspects of respiratoryfailure including physiology, interventions for respiratory support, advanced diagnostic techniques, qualityof life, and end of life care. Our common ground was passion for respiratory failure. The quality of thesessions during this 3-day conference was outstanding, and many of the presentations are still available forconference participants through the ERS website. However, the conference organisers felt that many of thetopics discussed deserved an even broader audience. We are happy that the editors of the EuropeanRespiratory Review have invited selected speakers to write a review based on the topic of their presentationduring the “Respiratory Failure and Mechanical Ventilation Conference”. The response has been fantastic,and the manuscripts provide an excellent overview of the topics covered during the conference andhighlight developments in the field of respiratory medicine. All the papers in this series are worth readingin detail, and we wish to highlight a few of them in this editorial.Advanced physiological respiratory monitoring is an attractive approach to individualise mechanicalventilation. Traditionally, clinicians rely on airway pressures measured by the ventilator during therespiratory cycle. In the absence of air flow (inspiratory or expiratory hold manoeuvre) the pressure in theventilator equals alveolar pressure (in the absence of airway collapse). However, from a physiologicalperspective, it is not the alveolar pressure that predicts alveolar injury. Distension of the alveolus, leadingto alveolar injury, is better reflected by the difference in alveolar and pleural pressure. The oesophagealpressure provides an estimation of pleural pressure and as reviewed by JONKMAN et al. [1] in a forthcomingarticle in this series, may help to deliver lung and diaphragm protective mechanical ventilation [2].Although we are waiting for clinical studies to provide evidence that oesophageal pressure monitoringimproves clinical outcome, a strong physiological rationale exists for this relatively simple and cheapmonitoring technique.Initiation of weaning is an important milestone for patients on invasive mechanical ventilation. Delayedweaning is associated with adverse clinical outcome [3]. The pathophysiology of difficult weaning iscomplex, and many reasons have been identified for difficult ventilator weaning [4]. In the current series,BUREAU et al. [5] discuss the pathophysiology of critical illness-associated respiratory muscle weakness andinterventions that may help to improve respiratory muscle strength and ultimately weaning outcome. BothCopyright ©The authors 2023This version is distributed underthe terms of the CreativeCommons Attribution Non-Commercial Licence 4.0. Forcommercial reproduction rightsand permissions contactpermissions@ersnet.orgReceived: 5 Feb 2023Accepted: 7 Feb 2023https://doi.org/10.1183/16000617.0027-2023 Eur Respir Rev 2023; 32: 230027EUROPEAN RESPIRATORY REVIEWEDITORIALL. HEUNKS AND M. DUIVERMANprevention of respiratory muscle weakness (diaphragm protective mechanical ventilation) and interventionsthat aim to improve strength are discussed in detail and are important for clinicians caring for weaningfailure patients.In patients with chronic respiratory failure, improvement of quality of life should be an important goalwhen starting home mechanical ventilation (HMV). This topic is discussed extensively in a forthcomingarticle by D’CRUZ et al. [6] entitled “Quality of life in patients with chronic respiratory failure on homemechanical ventilation”. Multiple factors, like the underlying cause of respiratory failure, disease severityat presentation, trajectory of respiratory failure progression, clinical response to HMV, the impact of thetreatment on the patient’s autonomy and caregiver wellbeing, patient’s preferences, values and beliefs, andsocial/environmental circumstances influence health perception in patients on HMV. The authorssummarise well-known health-related quality of life questionnaires developed for patients with respiratoryfailure [7], although they do recognise that more quantitative interviews might be needed to capture allthese elements. The challenge is to acknowledge all these factors and discuss them when decisions aboutmedical interventions need to be taken.In the review entitled “The role of telemonitoring in patients on home mechanical ventilation” [8], weaimed to discuss this upcoming way of working by reviewing studies on this topic and by placing theliterature in the context of daily practice and future perspectives. Initiation of chronic noninvasiveventilation at home is a cost-effective alternative to standard in-hospital initiation, and is, above all,preferred by patients who are severely disabled by their disease [9, 10]. Telemonitoring is already used inthe follow-up of patients on HMV but the methods of monitoring are diverse, and controlled studiescomparing this way of working with standard care are limited. A challenge for the coming years will be toprovide evidence-based guidance on how to effectively incorporate rapidly evolving e-heath technology inthe daily practice of HMV set-up and follow-up [11].We are confident that this series of papers will be of interest to clinicians and scientists interested inrespiratory failure and mechanical ventilation. If so, we hope to welcome you at the 2024 edition of theERS Respiratory Failure and Mechanical ventilation Conference! #RFMV2024.Provenance: Commissioned article, peer reviewed.Conflict of interest: L. Heunks has received grants or contracts from ZonMW (Dutch government), for clinicalresearch; consulting fees from Liberate Medical; payment or honoraria from American Thoracic Society; andreports leadership or fiduciary role as an Associate editor for the American Journal of Respiratory and Critical CareMedicine, and committees for ESICM and FERS, outside the submitted work. M.L. Duiverman has received researchgrants from RESMED, Philips, Lowenstein, Vivisol, Sencure, and Fisher&Paykel; and speaker fees from Chiesi andBreas, outside the submitted work.References1 Jonkman AH, Telias I, Spinelli E, et al. The oesophageal balloon for respiratory monitoring in ventilatedpatients: updated clinical review and practical aspects. Eur Respir Rev 2023; in press [https://doi.org/10.1183/16000617.0186-2022].2 Goligher EC, Jonkman AH, Dianti J, et al. Clinical strategies for implementing lung and diaphragm-protectiveventilation: avoiding insufficient and excessive effort. Intensive Care Med 2020; 46: 2314–2326.3 Pham T, Heunks L, Bellani G, et al. Weaning from mechanical ventilation in intensive care units across 50countries (WEAN SAFE): a multicentre, prospective, observational cohort study. Lancet Respir Med 2023; inpress [https://doi.org/10.1016/S2213-2600(22)00449-0].4 Heunks LM, van der Hoeven JG. Clinical review: the ABC of weaning failure--a structured approach. Crit Care2010; 14: 245.5 Bureau C, Van Hollebeke M, Dres M. Managing respiratory muscle weakness during weaning from invasiveventilation. Eur Respir Rev 2023; 32: 220205.6 D’Cruz RF, Kaltsakas K, Suh E-S, et al. Quality of life in patients with chronic respiratory failure on homemechanical ventilation. Eur Respir Rev 2023; in press [https://doi.org/10.1183/16000617.0237-2022].7 Struik FM, Kerstjens HA, Bladder G, et al. The Severe Respiratory Insufficiency Questionnaire scored best inthe assessment of health-related quality of life in chronic obstructive pulmonary disease. J Clin Epidemiol2013; 66: 1166–1174.8 van den Biggelaar R, Hazenberg A, Duiverman ML. The role of telemonitoring in patients on homemechanical ventilation. Eur Respir Rev 2023; 32: 220207.https://doi.org/10.1183/16000617.0027-2023 2EUROPEAN RESPIRATORY REVIEW RFMV CONFERENCE REVIEWS | L. HEUNKS AND M. DUIVERMAN9 Duiverman ML, Vonk JM, Bladder G, et al. Home initiation of chronic non-invasive ventilation in COPDpatients with chronic hypercapnic respiratory failure: a randomised controlled trial. Thorax 2020; 75: 244–252.10 van den Biggelaar RJM, Hazenberg A, Cobben NAM, et al. A randomized trial of initiation of chronicnoninvasive mechanical ventilation at home vs in-hospital in patients with neuromuscular disease andthoracic cage disorder: the dutch homerun trial. Chest 2020; 158: 2493–2501.11 Ambrosino N, Pierucci P. Using telemedicine to monitor the patient with chronic respiratory failure. Life(Basel) 2021; 11: 1113.https://doi.org/10.1183/16000617.0027-2023 3EUROPEAN RESPIRATORY REVIEW RFMV CONFERENCE REVIEWS | L. HEUNKS AND M. DUIVERMAN

EUR Research Repository

New insights into acute and chronic respiratory failure:highlights from the Respiratory Failure and MechanicalVentilation Conference 2022Leo Heunks1 and Marieke L. Duiverman 21Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. 2Department of PulmonaryDiseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Corresponding author: Leo Heunks (l.heunks@erasmusmc.nl)Shareable abstract (@ERSpublications)Highlights from the Respiratory Failure and Mechanical Ventilation Conference 2022 https://bit.ly/3HMWKTpCite this article as: Heunks L, Duiverman ML. New insights into acute and chronic respiratory failure:highlights from the Respiratory Failure and Mechanical Ventilation Conference 2022. Eur Respir Rev2023; 32: 230027 [DOI: 10.1183/16000617.0027-2023].The European Respiratory Society (ERS) is home to clinicians, scientists and students interested inrespiratory medicine. In June 2022, the Society organised the second edition of the “Respiratory Failureand Mechanical Ventilation Conference”. This event focuses on clinical and scientific aspects of acute andchronic respiratory failure. Faculty and participants from 50 countries around the globe met in Berlin,although this time most of the sessions could also be accessed online. Participants with very diversebackgrounds, including medicine, nursing, physiotherapy and industry, discussed all aspects of respiratoryfailure including physiology, interventions for respiratory support, advanced diagnostic techniques, qualityof life, and end of life care. Our common ground was passion for respiratory failure. The quality of thesessions during this 3-day conference was outstanding, and many of the presentations are still available forconference participants through the ERS website. However, the conference organisers felt that many of thetopics discussed deserved an even broader audience. We are happy that the editors of the EuropeanRespiratory Review have invited selected speakers to write a review based on the topic of their presentationduring the “Respiratory Failure and Mechanical Ventilation Conference”. The response has been fantastic,and the manuscripts provide an excellent overview of the topics covered during the conference andhighlight developments in the field of respiratory medicine. All the papers in this series are worth readingin detail, and we wish to highlight a few of them in this editorial.Advanced physiological respiratory monitoring is an attractive approach to individualise mechanicalventilation. Traditionally, clinicians rely on airway pressures measured by the ventilator during therespiratory cycle. In the absence of air flow (inspiratory or expiratory hold manoeuvre) the pressure in theventilator equals alveolar pressure (in the absence of airway collapse). However, from a physiologicalperspective, it is not the alveolar pressure that predicts alveolar injury. Distension of the alveolus, leadingto alveolar injury, is better reflected by the difference in alveolar and pleural pressure. The oesophagealpressure provides an estimation of pleural pressure and as reviewed by JONKMAN et al. [1] in a forthcomingarticle in this series, may help to deliver lung and diaphragm protective mechanical ventilation [2].Although we are waiting for clinical studies to provide evidence that oesophageal pressure monitoringimproves clinical outcome, a strong physiological rationale exists for this relatively simple and cheapmonitoring technique.Initiation of weaning is an important milestone for patients on invasive mechanical ventilation. Delayedweaning is associated with adverse clinical outcome [3]. The pathophysiology of difficult weaning iscomplex, and many reasons have been identified for difficult ventilator weaning [4]. In the current series,BUREAU et al. [5] discuss the pathophysiology of critical illness-associated respiratory muscle weakness andinterventions that may help to improve respiratory muscle strength and ultimately weaning outcome. BothCopyright ©The authors 2023This version is distributed underthe terms of the CreativeCommons Attribution Non-Commercial Licence 4.0. Forcommercial reproduction rightsand permissions contactpermissions@ersnet.orgReceived: 5 Feb 2023Accepted: 7 Feb 2023https://doi.org/10.1183/16000617.0027-2023 Eur Respir Rev 2023; 32: 230027EUROPEAN RESPIRATORY REVIEWEDITORIALL. HEUNKS AND M. DUIVERMANprevention of respiratory muscle weakness (diaphragm protective mechanical ventilation) and interventionsthat aim to improve strength are discussed in detail and are important for clinicians caring for weaningfailure patients.In patients with chronic respiratory failure, improvement of quality of life should be an important goalwhen starting home mechanical ventilation (HMV). This topic is discussed extensively in a forthcomingarticle by D’CRUZ et al. [6] entitled “Quality of life in patients with chronic respiratory failure on homemechanical ventilation”. Multiple factors, like the underlying cause of respiratory failure, disease severityat presentation, trajectory of respiratory failure progression, clinical response to HMV, the impact of thetreatment on the patient’s autonomy and caregiver wellbeing, patient’s preferences, values and beliefs, andsocial/environmental circumstances influence health perception in patients on HMV. The authorssummarise well-known health-related quality of life questionnaires developed for patients with respiratoryfailure [7], although they do recognise that more quantitative interviews might be needed to capture allthese elements. The challenge is to acknowledge all these factors and discuss them when decisions aboutmedical interventions need to be taken.In the review entitled “The role of telemonitoring in patients on home mechanical ventilation” [8], weaimed to discuss this upcoming way of working by reviewing studies on this topic and by placing theliterature in the context of daily practice and future perspectives. Initiation of chronic noninvasiveventilation at home is a cost-effective alternative to standard in-hospital initiation, and is, above all,preferred by patients who are severely disabled by their disease [9, 10]. Telemonitoring is already used inthe follow-up of patients on HMV but the methods of monitoring are diverse, and controlled studiescomparing this way of working with standard care are limited. A challenge for the coming years will be toprovide evidence-based guidance on how to effectively incorporate rapidly evolving e-heath technology inthe daily practice of HMV set-up and follow-up [11].We are confident that this series of papers will be of interest to clinicians and scientists interested inrespiratory failure and mechanical ventilation. If so, we hope to welcome you at the 2024 edition of theERS Respiratory Failure and Mechanical ventilation Conference! #RFMV2024.Provenance: Commissioned article, peer reviewed.Conflict of interest: L. Heunks has received grants or contracts from ZonMW (Dutch government), for clinicalresearch; consulting fees from Liberate Medical; payment or honoraria from American Thoracic Society; andreports leadership or fiduciary role as an Associate editor for the American Journal of Respiratory and Critical CareMedicine, and committees for ESICM and FERS, outside the submitted work. M.L. Duiverman has received researchgrants from RESMED, Philips, Lowenstein, Vivisol, Sencure, and Fisher&Paykel; and speaker fees from Chiesi andBreas, outside the submitted work.References1 Jonkman AH, Telias I, Spinelli E, et al. The oesophageal balloon for respiratory monitoring in ventilatedpatients: updated clinical review and practical aspects. Eur Respir Rev 2023; in press [https://doi.org/10.1183/16000617.0186-2022].2 Goligher EC, Jonkman AH, Dianti J, et al. Clinical strategies for implementing lung and diaphragm-protectiveventilation: avoiding insufficient and excessive effort. Intensive Care Med 2020; 46: 2314–2326.3 Pham T, Heunks L, Bellani G, et al. Weaning from mechanical ventilation in intensive care units across 50countries (WEAN SAFE): a multicentre, prospective, observational cohort study. Lancet Respir Med 2023; inpress [https://doi.org/10.1016/S2213-2600(22)00449-0].4 Heunks LM, van der Hoeven JG. Clinical review: the ABC of weaning failure--a structured approach. Crit Care2010; 14: 245.5 Bureau C, Van Hollebeke M, Dres M. Managing respiratory muscle weakness during weaning from invasiveventilation. Eur Respir Rev 2023; 32: 220205.6 D’Cruz RF, Kaltsakas K, Suh E-S, et al. Quality of life in patients with chronic respiratory failure on homemechanical ventilation. Eur Respir Rev 2023; in press [https://doi.org/10.1183/16000617.0237-2022].7 Struik FM, Kerstjens HA, Bladder G, et al. The Severe Respiratory Insufficiency Questionnaire scored best inthe assessment of health-related quality of life in chronic obstructive pulmonary disease. J Clin Epidemiol2013; 66: 1166–1174.8 van den Biggelaar R, Hazenberg A, Duiverman ML. The role of telemonitoring in patients on homemechanical ventilation. Eur Respir Rev 2023; 32: 220207.https://doi.org/10.1183/16000617.0027-2023 2EUROPEAN RESPIRATORY REVIEW RFMV CONFERENCE REVIEWS | L. HEUNKS AND M. DUIVERMAN9 Duiverman ML, Vonk JM, Bladder G, et al. Home initiation of chronic non-invasive ventilation in COPDpatients with chronic hypercapnic respiratory failure: a randomised controlled trial. Thorax 2020; 75: 244–252.10 van den Biggelaar RJM, Hazenberg A, Cobben NAM, et al. A randomized trial of initiation of chronicnoninvasive mechanical ventilation at home vs in-hospital in patients with neuromuscular disease andthoracic cage disorder: the dutch homerun trial. Chest 2020; 158: 2493–2501.11 Ambrosino N, Pierucci P. Using telemedicine to monitor the patient with chronic respiratory failure. Life(Basel) 2021; 11: 1113.https://doi.org/10.1183/16000617.0027-2023 3EUROPEAN RESPIRATORY REVIEW RFMV CONFERENCE REVIEWS | L. HEUNKS AND M. DUIVERMAN

University of GroningenNew insights into acute and chronic respiratory failureHeunks, Leo; Duiverman, Marieke L.Published in:European Respiratory ReviewDOI:10.1183/16000617.0027-2023IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2023Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Heunks, L., & Duiverman, M. L. (2023). New insights into acute and chronic respiratory failure: highlightsfrom the Respiratory Failure and Mechanical Ventilation Conference 2022. European Respiratory Review,32(168), Article 230027. https://doi.org/10.1183/16000617.0027-2023CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 01-01-2026New insights into acute and chronic respiratory failure:highlights from the Respiratory Failure and MechanicalVentilation Conference 2022Leo Heunks1 and Marieke L. Duiverman 21Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. 2Department of PulmonaryDiseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Corresponding author: Leo Heunks (l.heunks@erasmusmc.nl)Shareable abstract (@ERSpublications)Highlights from the Respiratory Failure and Mechanical Ventilation Conference 2022 https://bit.ly/3HMWKTpCite this article as: Heunks L, Duiverman ML. New insights into acute and chronic respiratory failure:highlights from the Respiratory Failure and Mechanical Ventilation Conference 2022. Eur Respir Rev2023; 32: 230027 [DOI: 10.1183/16000617.0027-2023].The European Respiratory Society (ERS) is home to clinicians, scientists and students interested inrespiratory medicine. In June 2022, the Society organised the second edition of the “Respiratory Failureand Mechanical Ventilation Conference”. This event focuses on clinical and scientific aspects of acute andchronic respiratory failure. Faculty and participants from 50 countries around the globe met in Berlin,although this time most of the sessions could also be accessed online. Participants with very diversebackgrounds, including medicine, nursing, physiotherapy and industry, discussed all aspects of respiratoryfailure including physiology, interventions for respiratory support, advanced diagnostic techniques, qualityof life, and end of life care. Our common ground was passion for respiratory failure. The quality of thesessions during this 3-day conference was outstanding, and many of the presentations are still available forconference participants through the ERS website. However, the conference organisers felt that many of thetopics discussed deserved an even broader audience. We are happy that the editors of the EuropeanRespiratory Review have invited selected speakers to write a review based on the topic of their presentationduring the “Respiratory Failure and Mechanical Ventilation Conference”. The response has been fantastic,and the manuscripts provide an excellent overview of the topics covered during the conference andhighlight developments in the field of respiratory medicine. All the papers in this series are worth readingin detail, and we wish to highlight a few of them in this editorial.Advanced physiological respiratory monitoring is an attractive approach to individualise mechanicalventilation. Traditionally, clinicians rely on airway pressures measured by the ventilator during therespiratory cycle. In the absence of air flow (inspiratory or expiratory hold manoeuvre) the pressure in theventilator equals alveolar pressure (in the absence of airway collapse). However, from a physiologicalperspective, it is not the alveolar pressure that predicts alveolar injury. Distension of the alveolus, leadingto alveolar injury, is better reflected by the difference in alveolar and pleural pressure. The oesophagealpressure provides an estimation of pleural pressure and as reviewed by JONKMAN et al. [1] in a forthcomingarticle in this series, may help to deliver lung and diaphragm protective mechanical ventilation [2].Although we are waiting for clinical studies to provide evidence that oesophageal pressure monitoringimproves clinical outcome, a strong physiological rationale exists for this relatively simple and cheapmonitoring technique.Initiation of weaning is an important milestone for patients on invasive mechanical ventilation. Delayedweaning is associated with adverse clinical outcome [3]. The pathophysiology of difficult weaning iscomplex, and many reasons have been identified for difficult ventilator weaning [4]. In the current series,BUREAU et al. [5] discuss the pathophysiology of critical illness-associated respiratory muscle weakness andinterventions that may help to improve respiratory muscle strength and ultimately weaning outcome. BothCopyright ©The authors 2023This version is distributed underthe terms of the CreativeCommons Attribution Non-Commercial Licence 4.0. Forcommercial reproduction rightsand permissions contactpermissions@ersnet.orgReceived: 5 Feb 2023Accepted: 7 Feb 2023https://doi.org/10.1183/16000617.0027-2023 Eur Respir Rev 2023; 32: 230027EUROPEAN RESPIRATORY REVIEWEDITORIALL. HEUNKS AND M. DUIVERMANprevention of respiratory muscle weakness (diaphragm protective mechanical ventilation) and interventionsthat aim to improve strength are discussed in detail and are important for clinicians caring for weaningfailure patients.In patients with chronic respiratory failure, improvement of quality of life should be an important goalwhen starting home mechanical ventilation (HMV). This topic is discussed extensively in a forthcomingarticle by D’CRUZ et al. [6] entitled “Quality of life in patients with chronic respiratory failure on homemechanical ventilation”. Multiple factors, like the underlying cause of respiratory failure, disease severityat presentation, trajectory of respiratory failure progression, clinical response to HMV, the impact of thetreatment on the patient’s autonomy and caregiver wellbeing, patient’s preferences, values and beliefs, andsocial/environmental circumstances influence health perception in patients on HMV. The authorssummarise well-known health-related quality of life questionnaires developed for patients with respiratoryfailure [7], although they do recognise that more quantitative interviews might be needed to capture allthese elements. The challenge is to acknowledge all these factors and discuss them when decisions aboutmedical interventions need to be taken.In the review entitled “The role of telemonitoring in patients on home mechanical ventilation” [8], weaimed to discuss this upcoming way of working by reviewing studies on this topic and by placing theliterature in the context of daily practice and future perspectives. Initiation of chronic noninvasiveventilation at home is a cost-effective alternative to standard in-hospital initiation, and is, above all,preferred by patients who are severely disabled by their disease [9, 10]. Telemonitoring is already used inthe follow-up of patients on HMV but the methods of monitoring are diverse, and controlled studiescomparing this way of working with standard care are limited. A challenge for the coming years will be toprovide evidence-based guidance on how to effectively incorporate rapidly evolving e-heath technology inthe daily practice of HMV set-up and follow-up [11].We are confident that this series of papers will be of interest to clinicians and scientists interested inrespiratory failure and mechanical ventilation. If so, we hope to welcome you at the 2024 edition of theERS Respiratory Failure and Mechanical ventilation Conference! #RFMV2024.Provenance: Commissioned article, peer reviewed.Conflict of interest: L. Heunks has received grants or contracts from ZonMW (Dutch government), for clinicalresearch; consulting fees from Liberate Medical; payment or honoraria from American Thoracic Society; andreports leadership or fiduciary role as an Associate editor for the American Journal of Respiratory and Critical CareMedicine, and committees for ESICM and FERS, outside the submitted work. M.L. Duiverman has received researchgrants from RESMED, Philips, Lowenstein, Vivisol, Sencure, and Fisher&Paykel; and speaker fees from Chiesi andBreas, outside the submitted work.References1 Jonkman AH, Telias I, Spinelli E, et al. The oesophageal balloon for respiratory monitoring in ventilatedpatients: updated clinical review and practical aspects. Eur Respir Rev 2023; in press [https://doi.org/10.1183/16000617.0186-2022].2 Goligher EC, Jonkman AH, Dianti J, et al. Clinical strategies for implementing lung and diaphragm-protectiveventilation: avoiding insufficient and excessive effort. Intensive Care Med 2020; 46: 2314–2326.3 Pham T, Heunks L, Bellani G, et al. Weaning from mechanical ventilation in intensive care units across 50countries (WEAN SAFE): a multicentre, prospective, observational cohort study. Lancet Respir Med 2023; inpress [https://doi.org/10.1016/S2213-2600(22)00449-0].4 Heunks LM, van der Hoeven JG. Clinical review: the ABC of weaning failure--a structured approach. Crit Care2010; 14: 245.5 Bureau C, Van Hollebeke M, Dres M. Managing respiratory muscle weakness during weaning from invasiveventilation. Eur Respir Rev 2023; 32: 220205.6 D’Cruz RF, Kaltsakas K, Suh E-S, et al. Quality of life in patients with chronic respiratory failure on homemechanical ventilation. Eur Respir Rev 2023; in press [https://doi.org/10.1183/16000617.0237-2022].7 Struik FM, Kerstjens HA, Bladder G, et al. The Severe Respiratory Insufficiency Questionnaire scored best inthe assessment of health-related quality of life in chronic obstructive pulmonary disease. J Clin Epidemiol2013; 66: 1166–1174.8 van den Biggelaar R, Hazenberg A, Duiverman ML. The role of telemonitoring in patients on homemechanical ventilation. Eur Respir Rev 2023; 32: 220207.https://doi.org/10.1183/16000617.0027-2023 2EUROPEAN RESPIRATORY REVIEW RFMV CONFERENCE REVIEWS | L. HEUNKS AND M. DUIVERMAN9 Duiverman ML, Vonk JM, Bladder G, et al. Home initiation of chronic non-invasive ventilation in COPDpatients with chronic hypercapnic respiratory failure: a randomised controlled trial. Thorax 2020; 75: 244–252.10 van den Biggelaar RJM, Hazenberg A, Cobben NAM, et al. A randomized trial of initiation of chronicnoninvasive mechanical ventilation at home vs in-hospital in patients with neuromuscular disease andthoracic cage disorder: the dutch homerun trial. Chest 2020; 158: 2493–2501.11 Ambrosino N, Pierucci P. Using telemedicine to monitor the patient with chronic respiratory failure. Life(Basel) 2021; 11: 1113.https://doi.org/10.1183/16000617.0027-2023 3EUROPEAN RESPIRATORY REVIEW RFMV CONFERENCE REVIEWS | L. HEUNKS AND M. DUIVERMAN

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