Analysis of Home Non-Invasive Ventilation ambulatory monitoring in chronic hypercapnic respiratory failure

Abstract

Home Non-Invasive Ventilation (HNIV) plays an important role in patients (pts) with chronic hypercapnic respiratory failure (CHRF) due to different diseases. Pts need to be carefully monitorated as indicated by SomnoNIV group.

Evaluate ventilatory pattern during HNIV in pts with CHRF due to different diseases by built-in monitoring data and arterial blood gases test.

118 patients (24 COPD,24 obesity-hypoventilation syndrome-OHS, 50 ALS,4 kyphoscoliosis, 8 myotonic dystrophy- MD1, 8 others neuromuscular diseases) were adapted to HNIV (T0) and followed after 1 month and 3 or 6 months (T1;T3-T6).

A significant PCO2 reduction in all groups already in T1 was found. At T0 lower IPAP was set in ALS than in others (ASL 11,73±0,32 cmH2O; COPD 14,63±0,48 cmH2O; OHS 15,29±0,57 cmH2O p<0,05). EPAP was higher in OHS than in COPD and in ALS groups (OHS 7,23±0,33 cmH2O; COPD 5,88±0,32 cmH2O; ASL 4,97±0,18 cmH2O; p<0,05). Spontaneous trigger percentage was significantly reduced in neuromuscular pts (ALS: T1 72,7% vs T6 61,9% p<0,05; MD1: T1 69,8% vs T6 45,3% p<0,05). After built-in software analysis 165 setting variations were performed overall, most of them were in ALS (n°75 variations).

At T6 a significant increase of HNIV dependence was found in ALS than others (T6: ASL 523,33±36 min; COPD 376 ±25 min; OHS 337,1±26 min; MD1 245±76 min p<0,05).

In ALS pts were found a lower IPAP, an increase HNIV dependence, a progressive reduction in spontaneous trigger percentage and a need of more setting variation due to disease progression. In OHS pts higher EPAP than in other groups was observed.

The key for efficacy HNIV setting is the evaluation of built-in monitoring data.