Ventilación mecánica no invasiva. Reflexiones sobre la monitorización a domicilio

Abstract

CIBERES, Ciber de enfermedades respiratorias, Spain Home-based noninvasive ventilation (NIV) was initiated in the early nineties in our environment as a treatment for patients with chronic respiratory failure, secondary to restrictive ventilatory disorders or neuromuscular disease. Subsequently, NIV also proved effective in patients with obesity-related hypoventilation syndromes, and to a lesser extent in some patients with chronic obstructive pulmonary disease in stable phase. There was a simultaneous growth in interest in whether the selected parameters suited the patients’ needs when using NIV in the home setting. Thus, the use of continuous overnight pulse oximetry monitoring as the gold standard for home monitoring in centers prescribing ventilation became widespread. The main issue with pulse oximetry has undoubtedly been its lack of specificity for correlation with certain patterns of patient–ventilator interaction. In other words, the effects of adverse events (desaturation) were detected, but there was a limited understanding of the underlying causes, and therefore of the potential solutions. In order to improve the performance of pulse oximetry, a series of simplified polygraphic systems have appeared in recent years, mostly in association with the ventilator manufacturers. These systems provide a set of data on the patient’s respiratory mechanics that can be downloaded from the ventilator’s internal memory. The main purpose is to provide the clinician with additional information on the potential reasons for inadequate ventilation periods and the pathophysiological causes (unintentional interface leaks, uncorrected upper airway episodes, asynchrony, etc.). Over the years, almost all manufacturers of ventilation systems have developed their own download system and data display. 1 However, in our view, the performance and reliability of these devices, which are widely used today, should be analyzed in depth. The first premise to be considered by the clinician is that a number of values provided by these software systems are not measured directly. In single-tube systems, the most widely used in home