Noninvasive Ventilation Devices Research Articles

Mask interfaces and devices for home noninvasive ventilation in children.

Home noninvasive ventilation (NIV), including continuous (CPAP) and bilevel (BPAP) positive airway pressure, is increasingly used in children worldwide. In this narrative review, we present a comprehensive summary of the equipment available for home NIV in pediatrics, excluding neonates. NIV may be challenging in young children, as the majority of the equipment has been developed for adults. Regarding the interfaces, only a few masks have been specifically developed for young children in recent years, while older children may benefit from a large variety of interfaces. Even though much progress has been made, skin injuries are still present, and need to be managed rapidly. Several studies addressed the management of the side effects, but recent studies are lacking regarding orofacial anomalies. No recent study reported the available interfaces for young children and the strategies for an optimal mask fit. Regarding the devices, an adapted NIV device to pediatrics that allows an adequate patient's breathing detection should guarantee optimal ventilatory efficiency and monitoring of NIV. A close follow-up and regular monitoring should be mandatory to rule out the potential issues, optimize NIV therapy and ascertain the efficacy of NIV. However, studies are lacking to guide the choice of devices in young children and the optimal management of home NIV in pediatrics. We summarized the characteristics of the different interfaces available for young children and the limitations of NIV devices. We finally addressed potential areas for future research on long-term home NIV in children.

RECOMMENDATIONS FOR PREVENTION AND CONTROL OF INFECTION IN NON-INVASIVE VENTILATION IN HOSPITAL ENVIRONMENT

There are numerous studies and recommendations on the complications associated with invasive mechanical ventilation, but few on prevention and control of infection in non-invasive ventilation (NIV), especially at the hospital environment. Healthcare workers (HCW) should be alert to the potential risk of transmission of infection in NIV. The main goal of this manuscript is to establish and promote good practices in the prevention and control of infections associated with NIV, as well as the development of a document that can serve as a guideline for HCW. A review of the literature on cleaning and disinfection of devices in NIV was carried out between February 2019 and August 2020 and the technical specifications of NIV devices, published by the manufacturers, were also analyzed. NIV devices require a high level of disinfection using chemical disinfectants. It is necessary to clean and disinfect the surface of the ventilator daily, while the rest of the components should be cleaned and disinfected with a weekly frequency. It should avoid active humidification when possible, favoring passive humidification. Using a bacteriological filter is extremely important in a hospital environment and should be considered. In patients with COVID-19, it is also recommended to use non-ventilated interfaces and 2 filters, one bacteriological at the outlet of the ventilator and another preferably Heat and Moisture Exchanging Filter (HMEF) in the interface. The cleaning and disinfection instructions for NIV are based on recommendations for decontamination of semi-critical material and basic infection control precautions. This document provides an orientation guide of the main procedures to be implemented in the prevention and control of infection in NIV that must be adapted to each hospital.

Safety and efficacy of noninvasive ventilation for acute respiratory failure in general medical ward: a prospective cohort study.

Noninvasive ventilation (NIV) is recommended for use in patients with acute respiratory failure of various etiologies. However, we do not know whether the use of NIV in general medical wards is safe and effective. This study aimed to evaluate the safety and efficacy of using NIV and factors associated with NIV failure in general medical wards. A prospective cohort study was conducted in general medical wards of the University Hospital. Adult patients with acute respiratory failure treated with NIV were enrolled. The subjects were managed by a multidisciplinary care team that was well trained in the NIV device. The primary outcome was the rate of NIV failure at 48 hours. Secondary outcomes included hospital mortality and factors associated with NIV failure. A total of 86 patients were enrolled. The mean age was 70±17 years old. The Acute Physiology and Chronic Health Evaluation (APACHE) III and the Sequential Organ Failure Assessment (SOFA) scores were 56±17 and 4±3, respectively. The most common indication of NIV use was cardiogenic pulmonary edema (34.9%). The rate of NIV failure at 48 hours and hospital mortality were 20.9% and 12.8%, respectively. The SOFA score was associated with failure of NIV at 48 hours [odds ratio (OR) 1.48, 95% confidence interval (CI): 1.16-1.89; P=0.002]. NIV was safe and effective on general medical wards. Cardiogenic pulmonary edema was the most common indication for the application of NIV. The SOFA score was associated with the failure of NIV at 48 hours.

Exploring clinicians' beliefs and practices regarding Non-Invasive Ventilation devices: An international survey study

Introduction Non-invasive ventilation (NIV) has a significant role in supporting patients with respiratory failure with the goal of avoiding mechanical ventilation. Traditionally, NIV has been applied using dedicated NIV-specific devices but over the last decade, newer generation critical care ventilators have updated their capabilities to include NIV options with improved synchrony and leak compensation. No recent trials have compared the efficacy of new generation critical care ventilators to NIV ventilators. The purpose of this study was to evaluate clinicians attitudes and perceptions toward the use of NIV between the dedicated NIV and critical care ventilators. Methods An online survey of clinicians with seven questions regarding their thoughts and experience in using NIV in acute care settings was posted online and promoted through emails and social media. The survey was anonymous and an exemption of consent was obtained from the Institutional Review Board. Analysis of variants (ANOVA) was done for the total responses in each question, followed by multivariate analysis of variants (MANOVA) for responses per occupation. Results 514 responses from 54 countries were recorded. 151 from North America, 109 from South America, 125 from Europe, 97 from Asia, 21 from Africa, and 11 from Australia. 218 responders were physicians, 218 were respiratory therapists, 28 were nurses, and 50 were reported as other professionals (engineers, biomedical technicians). 346 (67.3%) reported using both types of ventilators for NIV, 91 (17.7%) use only NIV -specific devices, and 77 (15%) only use critical care ventilators (P 0.097), responses per occupation (P < 0.001). 290 (56.4%) have automatic synchronization software on either of their ventilators, 113 (22%) do not, while 111 (21.6%) are unsure if they do (P 0.22), with significant variation by occupation (P 0.008). Regarding synchrony, 233 (45.3%) said NIV ventilators are better, and 165 (32.1%) said critical care ventilators are better, while 116 (22.5%) said both are similar (P 0.59) with significant variation by occupation (P 0.04). Regarding leak compensation, 241 (46.9%) said NIV ventilators are better, and 146 (284%) said critical care ventilators are better, while 127 (24.7%) said both are similar (P 0.6) without significant variation by occupation (P 0.07). Regarding the general opinion of superiority, 273 (53.1%) said NIV ventilators are better, 131 (25.5%) said critical care ventilators are better, and 110 (21.4%) said both are similar (P 0.42) without significant variation by occupation (P 0.098). Conclusion Despite the lack of evidence, there is wide variability in opinion with no clear consensus regarding the clinicians’ attitude towards which ventilators are superior to use during NIV, especially according to surveyed occupation.

Home NIV treatment quality in patients with chronic respiratory failure having participated to the French nationwide telemonitoring experimental program (The TELVENT study)

BackgroundThe ETAPES program is a national telemedicine experiment conducted in France between 2018 and 2023 to investigate whether home non-invasive ventilation (NIV) telemonitoring improves healthcare pathways in patients with chronic respiratory failure (CRF) and impacts healthcare organization. The program provides a combination of therapeutic education and NIV telemonitoring with data processed by an algorithm generating alerts. The TELVENT study objective was to analyze the evolution of ventilation quality in patients included in the ETAPES program. MethodsMulticentric cohort study on patients undergoing long-term NIV included in the ETAPES program between September 2018 and December 2020 and who did not refuse the use of their data for this research. Data were obtained from homecare provider databases. The primary endpoint was to attain successful NIV treatment, which was determined by a combination of daily NIV usage for > 4 h per day, low leaks, and a low apnea-hypopnea index (AHI) identified by the NIV device. Respiratory disability was assessed using the DIRECT questionnaire. Results329 patients were included in the study of which 145 had COPD and 83 had started NIV and ETAPES within one-month delay. Approximately 25% of patients did not achieve the criteria for successful NIV at ETAPES entry. The proportion of patients with successful NIV treatment increased to 86.8% at six months (p = 0.003, Cochran-Armitage trend test) regardless of NIV history and continued to increase at 12 months in newly equipped NIV patients (93.8%, at month 12, p = 0.0026 for trend test). Over time, a significant increase in NIV use and compliance was observed, while AHI significantly decreased in the overall population. No significant decrease was observed for non-intentional leaks. Approximately 4.9 alerts were generated per patient per 6 months. Their number and type (low NIV use, high AHI or leaks) differed among patients based on their NIV history. Respiratory disability score decreased over time compared with baseline. ConclusionThe TELVENT study highlights the importance of remote NIV monitoring to rapidly identify patients with unsuccessful ventilation. The combination of remote monitoring and therapeutic education may improve the quality of home NIV, especially in the first months of treatment.

Noninvasive Ventilation Automated Technologies: A Bench Evaluation of Device Responses to Sleep-Related Respiratory Events.

Noninvasive ventilation (NIV) is the reference standard treatment for most situations of chronic respiratory failure. NIV settings must be titrated to both preserve upper-airway patency and control hypoventilation. Automatic adjustment of pressure support (PS) and expiratory positive airway pressure (EPAP) may facilitate the initiation and follow-up of domiciliary NIV. However, whether the automatic-adjustment algorithms embedded into current devices accurately detect, respond to, and score common sleep-related respiratory events remains unclear. A bench was set up to simulate central hypopnea (CH), central apnea (CA), obstructive hypopnea (OH), and obstructive apnea (OA). Four home ventilators were evaluated, with their dedicated modes for automatic PS and EPAP adjustment. All 4 devices increased PS during CH, CA, and OH. However, PS adjustment varied widely in magnitude, with tidal volumes within 100 ± 20% of the target being provided by only 3 devices for CH, one for CA, and one for OH. Two devices increased EPAP for OH and 3 for OA, including one that also increased EPAP for CA. Only 2 devices scored residual hypopnea after simulated CA, and only one scored a residual event after OH. One device scored no event. Current NIV devices differed markedly in their responses to, and reporting of, standardized sleep-related respiratory events. Further improvements in embedded NIV algorithms are needed to allow more widespread out-of-laboratory initiation and follow-up of NIV.

P.112 Impact of nusinersen on respiratory progression in paediatric patients with spinal muscular atrophy type 2 and non-ambulant type 3

Nusinersen treatment provides significant functional motor benefit in the chronic forms of spinal muscular atrophy (SMA). Less is known on respiratory outcomes in nusinersen treated patients. Only short-term results on forced vital capacity (FVC) have been reported in heterogeneous treated SMA cohorts. Aim of this study is to evaluate the impact of nusinersen on respiratory function across the iSMAC international cohort of paediatric SMA2 and non-ambulant SMA3 patients (Italian SMA network, US PNCR, UK SMA REACH) when compared to the natural history data (NH) recently published by the consortium. Five-year retrospective study of SMA2 and non-ambulant SMA3 children (age 5-16years) treated with nusinersen within iSMAc centres. We collected lung function expressed as Forced vital capacity absolute and %predicted (FVC %pred), use of non-invasive ventilation (NIV) and cough device. Data was available for 100 patients 81 SMA2, 19 SMA3. Mean (SD) age at first injection was 8(3.3) and 9.4(3.8) years in SMA2 and 3 respectively. Mean disease duration prior to treatment was 7.1(3.3) and 7.3(3.9) years. At first injection 34/65(52%) SMA2 and 2/19 SMA3(11%) were on NIV; 49/65 (75%) SMA2 and 6/20(30%) SMA3 used cough devices. Mean FVC%pred (SD) at first treatment was 53.9(25.8) and 80.6(12.0) respectively. Up to age 13 years, when the respiratory decline is steeper, in treated SMA2 FVC% declined by 2.2%/year vs 4.2% NH, in treated SMA3 FVC% declined by 1.4% vs 6.3%. In the few patients older than 13 years (13 SMA2, 7 SMA3), a clear treatment effect was not detected. One year post treatment 4/36 patients were weaned off NIV, whilst 7, who were self-ventilating at baseline, were established on NIV. This study on the largest cohort of chronic SMA reported so far, confirms the positive role of nusinersen in delaying the respiratory decline in paediatric patients with SMA2 and non-ambulant SMA3 younger than 13 years when compared to natural history. Larger cohorts and longer observation are required to evaluate the role of nusinersen on older patients.

Cost-effectiveness of outpatient versus inpatient non-invasive ventilation setup in obesity hypoventilation syndrome: the OPIP trial

BackgroundCurrent guidelines recommend that patients with obesity hypoventilation syndrome (OHS) are electively admitted for inpatient initiation of home non-invasive ventilation (NIV). We hypothesised that outpatient NIV setup would be more...

STARTED FROM THE BOTTOM, NOW WE'RE HERE: THE UNRELENTING CASE OF CHARCOT MARIE TOOTH DISEASE FROM ANKLE WEAKNESS, TO VENOUS THROMBOEMBOLI, TO VENTILATOR DEPENDENCE

TYPE: Case Report TOPIC: Genetic and Developmental Disorders INTRODUCTION: Charcot Marie Tooth Disease Type 4J (CMT4J) is a rare inherited peripheral neuropathy caused by mutations of the lipid phosphatase FIG4 gene. Severe forms may lead to respiratory dysfunction. CASE PRESENTATION: A 44 year old male had an initial complaint of falls due to bilateral foot drop. Nerve conduction studies demonstrated axonal and demyelinating polyneuropathy. This raised suspicion for chronic inflammatory demyelinating polyneuropathy. He was started on intravenous immunoglobulin treatments and corticosteroids with no improvement, and soon he became wheelchair bound. 3 months after initial presentation, he developed shortness of breath and chest pain; he was diagnosed with provoked bilateral pulmonary emboli with pulmonary infarcts and started on rivaroxaban. Pulmonary function testing revealed severe restrictive lung disease with decreased respiratory muscle force necessitating a non-invasive auto-titration ventilation device (AVAPS-AE). Genetic testing performed at 4 months since initial symptoms revealed a heterozygous missense variant in the FIG4 gene consistent with CMT4J. 6 months after initial presentation, he went into cardiac arrest due to hypercapnic respiratory failure; return of spontaneous circulation was achieved, and eventually he underwent a tracheostomy and became ventilator dependent. DISCUSSION: CMT4J is a rapidly progressive pure motor neuron type of CMT which mimics amyotrophic lateral sclerosis. This case highlights the course of the disease as it relates to the timing of symptom onset, diagnosis, and the most crippling complication that is respiratory failure. CONCLUSIONS: Peripheral neuropathies, especially in the benign phases, should provoke early and broad screening, genetic testing, and advanced planning with regard to the devastating sequelae of ascending neuromuscular weakness. DISCLOSURE: Nothing to declare. KEYWORD: Charcot Marie Tooth

Treatment of COVID-19 Acute Respiratory Distress Syndrome With a Tabletop Noninvasive Ventilation Device in a Respiratory Intermediate Care Unit.

ObjectiveTo study the outcomes of noninvasive ventilation (NIV) administered through a tabletop device for coronavirus disease 2019 acute respiratory distress syndrome in the respiratory intermediate care unit (RIMCU) at a tertiary care hospital in India.Patients and MethodsWe retrospectively studied a cohort of hospitalized patients deteriorating despite low-flow oxygen support who received protocolized management with positive airway pressure using a tabletop NIV device in the RIMCU as a step-up rescue therapy from July 30, 2020 to November 14, 2020. Treatment was commenced on the continuous positive airway pressure mode up to a pressure of 10 cm of H2O, and if required, inspiratory pressures were added using the bilevel positive air pressure mode. Success was defined as weaning from NIV and stepping down to the ward, and failure was defined as escalation to the intensive care unit, the need for intubation, or death.ResultsIn total, 246 patients were treated in the RIMCU during the study period. Of these, 168 received respiratory support via a tabletop NIV device as a step-up rescue therapy. Their mean age was 54 years, and 83% were men. Diabetes mellitus (78%) and hypertension (44%) were the commonest comorbidities. Treatment was successful with tabletop NIV in 77% (129/168) of the patients; of them, 41% (69/168) received treatment with continuous positive airway pressure alone and 36% (60/168) received additional increased inspiratory pressure via the bilevel positive air pressure mode.ConclusionRespiratory support using the tabletop NIV device was an effective and economical treatment for coronavirus disease 2019 acute respiratory distress syndrome. Further studies are required to assess the appropriate time of initiation for maximal benefits and judicious utilization of resources.

Factors associated with the lethality of patients hospitalized with severe acute respiratory syndrome due to COVID-19 in Brazil.

Due to the high rates of transmission and deaths due to COVID-19, understanding the factors associated with its occurrence, as well as monitoring and implementing control measures should be priority actions in health surveillance, highlighting the use of epidemiological surveillance information systems as an important ally. Thus, the objectives of this study were to calculate the mortality rate of hospitalized patients with severe acute respiratory syndrome due to COVID-19 and to identify factors associated with death, in the period corresponding to epidemiological weeks 01 to 53 of the year 2020. This was a longitudinal study, using the national influenza epidemiological surveillance information system database, routinely collected by healthcare services. The sociodemographic and clinical characteristics of 563,051 hospitalized patients with severe acute respiratory syndrome due to COVID-19 in the five regions of Brazil were analyzed. Cox regression was performed to assess factors associated with patient death during hospitalization. The national lethality rate was 35.7%, and the highest rates of lethality occurred in the Northeast (44.3%) and North (41.2%) regions. During the hospital stay, death was associated with older age (Hazard Ratio-HR = 1.026; p<0.001); male sex (HR = 1.052; p<0.001); living in the North (HR = 1.429; p<0.001), Northeast (HR = 1.271; p<0.001) or Southeast regions of Brazil (HR = 1.040; p<0.001), presenting any risk factor (HR = 1.129; p< 0.001), the use of invasive (HR = 2.865; p<0.001) or noninvasive (HR = 1.401; p<0.001) mechanical ventilation devices. A high case lethality rate was evidenced in patients with severe acute respiratory syndrome due to COVID-19, however, deaths were not evenly distributed across the country's regions, being heavily concentrated in the Northeast and North regions. Older male patients living in the North, Northeast, or Southeast regions of Brazil, who presented any risk factor and were submitted to the use of invasive or noninvasive mechanical ventilation devices, presented a higher risk of evolving to death.

Structured practices increasing patient compliance to noninvasive mechanical ventilation therapy: example of best practice

Aim: The initiation of non-invasive mechanical ventilation (NIV) therapy, mask choice, device settings, and patient follow-up are carried out jointly by physicians and nurses. The physician and the nurses should have knowledge and experience. A checklist for the patient follow-up may increase identifying and preventing problems that may occur. Our study aims to share our data and experiences by documenting the NIV implementation success of our pulmonary intensive care unit (PICU) as an example of best practice.&#x0D; Material and Method: Patients with respiratory failure who had an indication for NIV therapy between 01.01.2021 and 15.09.2021 were included in the study. Patient data were obtained retrospectively. With the NIV therapy application checklist, what should be done in the preparations, initiation, and follow-up steps of the therapy are standardized. All checkpoints and the outcome of the checklist were recorded routinely.&#x0D; Results: One hundred one patients with the diagnosis of hypercapnic respiratory failure treated by NIV therapy in PICU were included in the study. There was a significant difference between NIV compliant and NIV noncompliant patients in terms of PaCO2 in arterial blood gas analysis (p=0.009). PaCO2 was significantly lower in patients who were noncompliant to treatment than those who were compliant with treatment (p

COVID-19: non-invasive oxygenation and ventilation devices in pre-hospital settings

COVID-19: non-invasive oxygenation and ventilation devices in pre-hospital settings

Siblings of children with a complex chronic disorder treated by non-invasive ventilation.

The aim of the study was to assess the emotional and behavioural functioning of siblings of children treated with long term non-invasive ventilation (NIV). Parents of children treated with NIV completed the Child Behaviour Checklist and a qualitative questionnaire for each sibling, aged 1.5-18 years old. The parents of 49 ventilated children were questioned about 79 siblings. For the siblings aged 1.5-5, mean total T score was 57 ± 22 (range 28-92), and five siblings (31%) were in the clinical range. For the siblings aged 6-18, mean total T score was 49 ± 12 (range 26-71), and six siblings (10%) were in the clinical range. Siblings felt responsible for their affected sibling (31%) and involved with his/her illness (52%), with 31% being worried about him/her. A change in behaviour was observed in 19% of the siblings since the initiation of NIV; 26% were impacted by the use of the NIV device. The majority of siblings of children treated with NIV do not present significant emotional and behavioural problems. They feel deeply responsible for their affected sibling and involved in his/her illness and treatment, highlighting the importance to involve the siblings in the care of the affected child.

P004 Non-Invasive Ventilation - Partnering with Paediatric NDIS participants and their families

Abstract To discuss a new funding pathway for Non-Invasive ventilation (NIV) in Paediatrics. Since October 2019, the National Disability Insurance Scheme (NDIS) introduced funding for NDIS participants in the category ‘Disability-related Health Supports - Respiratory Support’. From August 2020, a nursing project was funded by the Hospital Executive to facilitate the transfer of NIV consumable costs to the NDIS. A retrospective review of 256 NIV patients (Bi-Level Positive Airway Pressure (BiPAP) and Continuous Positive Airway Pressure (CPAP)) and the patients NDIS eligibility status. 110 patients were identified as potential NDIS eligible patients by Primary diagnosis and their families contacted and supported to access NDIS funding for NIV device and consumables. By May 2021, 163 patients were NDIS participants on NIV therapy. Formal Assistive Technology (Respiratory ventilation) requests were developed with Key stakeholder input and supplier quotes obtained for machines and consumables. Nursing support, whilst labour intensive has shown to benefit Paediatric patients and their families accessing NDIS funding for NIV therapy in the future. Furthermore, the purchasing of disability-related health supports through NDIS funding is an alternative funding model for NIV in Paediatrics.

The Correlation Between Non-Invasive Ventilation Use and the Development of Dry Eye Disease.

The use of non-invasive ventilation (NIV) devices such as continuous positive airway pressure and bi-level positive airway pressure machines have been associated with an increased incidence of dry eye disease (DED). To understand how the use of these ventilation masks impacts the eyes, a review of the pathophysiology of DED and an evaluation of recent studies investigating the effects of NIV use on the severity and incidence of this condition were performed. It was found that the use of face masks associated with the ventilation devices exhibited a positive correlation to the incidence and severity of numerous ocular pathologies. However, the benefits of non-invasive mechanical ventilation are undeniable in treating conditions such as obstructive sleep apnea, chronic obstructive pulmonary disease, and respiratory failure; therefore, proper education, behavioral modifications, and treatment can help reduce or prevent the adverse effects that NIV have on the eyes.

Factors Associated With Hospitalisation of Copd Exacerbations During a Winter Season In an Emergency Ward

Objectives: Chronic obstructive pulmonary disease (COPD) is a difficult chronic illness to manage because it causes prolonged hospital admissions and repeated applications. We aimed to examine the factors affecting this situation in a winter emergency in a chest diseases emergency. Material and Method: We conducted a retrospective study in our emergency department (ED) with patients who admitted due to COPD exacerbations. Factors affecting hospitalization and ICU requirement were evaluated.&#x0D; Results: Totally 128 patients were included. Mean number for ED admissions was 3.01±2.1. There were 73 (57%) hospitalized patients and 17(13.3%) patients transferred to intensive care unit (ICU). White blood cell (WBC) and C reactive protein (CRP) were significantly higher in patients with ≥3 ED admissions than others (p=0.06 and p=0.007 respectively). Among categorical variables being current smoker, long time oxygen therapy (LTOT) and non-invasive mechanical ventilation (NIMV) devices and existence of bronchiectasis were related to frequent ED admission (p=0.025, p=0.01, p=0.046 and p=0.028 respectively). Existence of pneumonia and comorbidities had positive and significant correlations with hospitalization (r=0.18, p=0.04 and r=0.26, p=0.02). In terms of ICU requirement, pneumonia, partial arterial pressure of carbon dioxide (PaCO2) value and mean pulmonary arterial pressure (PAB) had significant correlations (r=0.27, p=0.001, r=0.34, p

Determinants of usage and nonadherence to noninvasive ventilation in children and adults with Duchenne muscular dystrophy.

Duchenne muscular dystrophy (DMD) is a neuromuscular disorder that leads to chronic respiratory insufficiency and failure. Use of home noninvasive ventilation (NIV) has been linked to improved outcomes including reduced mortality. Despite the importance of NIV, factors promoting optimal NIV usage and determinants of nonadherence have not been rigorously examined. Moreover, given that respiratory issues in DMD span between childhood and adulthood, examination across a broad age group is needed. The objectives of this study were to (1) evaluate NIV usage across a broad spectrum of patients with DMD, including both children and adults, and (2) identify biological and socioeconomic determinants of NIV usage and NIV nonadherence. We performed a retrospective review of all patients with DMD from February 2016 to February 2020 who underwent evaluation at associated pediatric and adult neuromuscular disease clinics. NIV use was determined objectively from device downloads. A priori, we defined nonadherence as < 4 hours use per night, quantified as the percentage of nights below this threshold across a 30-day period within 6 months of a clinic visit. We also assessed the average hours of NIV usage over this time period. Predictors examined included demographics, social determinants, and pulmonary function. 33 patients with DMD were identified, 29 (87%) of whom were using NIV (13 age < 21 years). Mean age was 22.9 ± 6.6 years (range 13-39 years), body mass index was 23.4 ± 10.4 kg/m2, and seated forced vital capacity was 23% ± 18% predicted. Mean nightly NIV usage was 7.4 ± 3.8 hours and mean percentage of nonadherent nights was 13% ± 30%. In univariable analysis, age did not predict use. Those with lower forced vital capacity had higher NIV usage hours (P = .01) and a trend toward less nonadherence (P = .06). Higher estimated household income demonstrated a trend toward increased usage hours and less nonadherence (both P = .08). Multivariable analysis found increased usage hours were predicted best by higher income, higher inspiratory positive airway pressure, and higher bicarbonate. Nonadherence was higher in those with lower income or higher forced vital capacity. In this cohort of adult and pediatric patients with DMD, most individuals were using NIV. While usage hours were higher with lower lung function, substantial variability remains unexplained by examined factors. Nonadherence was observed in some individuals, including those with advanced disease. Further investigations should focus on evaluating patient-oriented outcomes to define optimal NIV usage across the spectrum of disease and determine strategies to counteract issues with nonadherence. Hurvitz MS, Bhattacharjee R, Lesser DJ, Skalsky AJ, Orr JE. Determinants of usage and nonadherence to noninvasive ventilation in children and adults with Duchenne muscular dystrophy. J Clin Sleep Med. 2021;17(10):1973-1980.

Portable NIV for patients with moderate to severe COPD: two randomized crossover trials

BackgroundLong-term non-invasive ventilation (NIV) is as an established treatment option for chronic hypercapnic COPD patients. Beneficial effects have also been shown during exercise, but this is restricted to rehabilitation programs. New portable NIV (pNIV) devices may now enable NIV application during walking at home.Study design and methodsIn two randomized crossover trials, the impact of pNIV on dyspnea and endurance capacity was investigated in patients with moderate to severe COPD. Participants performed a standardized 6-min walking test, with and without pNIV, using a pre-set inspiratory/expiratory positive airway pressure of 18/8 cmH2O. The first study was performed in NIV-naïve patients (Study I), while the second study was performed in those already established on long-term NIV (Study II).Results38 patients (66.9 ± 7.4 years, mean FEV1: 30.3 ± 8%pred) and 23 patients (67.6 ± 8.7 years, mean FEV1: 29.8 ± 10.4%pred) participated in Study I and II, respectively. In Study I, the mean difference in the Borg Dyspnea Scale (BDS, primary outcome) score following walking was 3.2 (IQR 2–4) without pNIV, compared to 2.6 (IQR 1–4) with pNIV (ΔBDS 0.65, P = 0.04), while walking distance increased from 311.8 m (95%CI 276.9–346.6 m) to 326.3 m (95%CI 291.5–361.2 m) (P = 0.044) when pNIV was used. Accordingly, in Study II, the mean difference in BDS was 4.4 (IQR 3–6) without pNIV, compared to 4.5 (IQR 3–6) with pNIV (ΔBDS 0.09, P = 0.54), while walking distance decreased from 291.5 m (95%CI 246.1–336.9 m) to 258.4 m (95%CI 213–303.8 m) (P ≤ 0.001).InterpretationThe use of a pNIV device during walking can improve dyspnea and walking distance in patients with moderate to severe COPD. Patients who do not already receive long-term NIV therapy are more likely to benefit compared to those undergoing long-term NIV. Careful patient selection is mandatory.Clinical Trial Register: DRKS00013203; DRKS00012913 registered October 20th 2017 and October 16th 2017; https://www.drks.de/drks_web/

Noninvasive Ventilation Downloads and Monitoring.

"Home noninvasive ventilation (NIV) is indicated for numerous conditions including neuromuscular disease, thoracic cage disorders, chronic obstructive pulmonary disease, and hypoventilation syndromes. Effective management of patients on home NIV requires clinicians to interpret data downloads from NIV devices. Clinicians must first look at adherence and factors that may impact this including mask comfort and fit. Next, leak assessment is undertaken. Once these are addressed, such information as apnea-hypopnea index, exhaled tidal volume, and percent triggered breaths help clinicians troubleshoot setting changes. Finally, overnight oximetry and transcutaneous CO2 monitoring are useful adjuncts to the data download to optimize NIV settings."