Management of Home Mechanical Ventilation (HMV) patients admitted in Hypercapnic Respiratory Failure (HRF): reported confidence versus practice

Abstract

Despite increasing use of HMV, a sub-group of patients require hospitialisation with acute HRF. Management of these patients may require alterations to ventilator settings. To ascertain if respiratory physiotherapists, managing HMV patients admitted due to acute HRF, feel confident to alter ventilator settings, and if this is reflected in practice. Respiratory physiotherapists anonymously completed a survey outlining their exposure to HMV patients, confidence to alter device settings and identify situations they would do so. Retrospective Non-Invasive Ventilation data including initial settings and titration were compared with the patient’s HMV settings prior to admission. Patients on maximum settings or who had corrected arterial pH on HMV settings were excluded. 84% of respondents had reviewed an HMV patient in the last 6 months. 100% identified a clinical need for settings change in patients with acute HRF, with 72% reporting confidence to do so. Despite this and an initial arterial blood gas demonstrating academia and hypercapnia, only 35% of patients had settings modified. 31% of patients with Chronic Obstructive Pulmonary Disease (COPD) patients had settings adjusted versus to 50% in non-COPD patients. Within the limited scope of this review, self- reported confidence to alter settings in HMV patients with HRF did not translate into clinical practice. As delays in treating HRF may have negative consequences, translating confidence into practice by those providing care to HMV patients across the chronic and acute spectrum is essential. Underlying condition may be a factor the decision making process, which would benefit from further study