Assistive technologies for home NIV in patients with COPD: feasibility and positive experience with remote-monitoring and volume-assured auto-EPAP NIV mode

McDowell, G., Sumowski, M., Toellner, H., Karok, S., O'Dwyer, C., Hornsby, J., Lowe, D. J. and Carlin, C. M. (2021) Assistive technologies for home NIV in patients with COPD: feasibility and positive experience with remote-monitoring and volume-assured auto-EPAP NIV mode. BMJ Open Respiratory Research, 8(1), e000828. (doi: 10.1136/bmjresp-2020-000828)

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Abstract

Background: Outcomes for patients with chronic obstructive pulmonary disease (COPD) with persistent hypercapnic respiratory failure are improved by long-term home non-invasive ventilation (NIV). Provision of home-NIV presents clinical and service challenges. The aim of this study was to evaluate outcomes of home-NIV in hypercapnic patients with COPD who had been set-up at our centre using remote-monitoring and iVAPS-autoEPAP NIV mode (Lumis device, ResMed). Methods: Retrospective analysis of a data set of 46 patients with COPD who commenced remote-monitored home-NIV (AirView, ResMed) between February 2017 and January 2018. Events including time to readmission or death at 12 months were compared with a retrospectively identified cohort of 27 patients with hypercapnic COPD who had not been referred for consideration of home-NIV. Results: The median time to readmission or death was significantly prolonged in patients who commenced home-NIV (median 160 days, 95% CI 69.38 to 250.63) versus the comparison cohort (66 days, 95% CI 21.9 to 110.1; p<0.01). Average time to hospital readmission was 221 days (95% CI, 47.77 to 394.23) and 70 days (95% CI, 55.31 to 84.69; p<0.05), respectively. Median decrease in bicarbonate level of 4.9 mmol/L (p<0.0151) and daytime partial pressure of carbon dioxide 2.2 kPa (p<0.032) in home-NIV patients with no required increase in nurse home visits is compatible with effectiveness of this service model. Median reduction of 14 occupied bed days per annum was observed per patient who continued home-NIV throughout the study period (N=32). Conclusion: These findings demonstrate the feasibility and provide initial utility data for a technology-assisted service model for the provision of home-NIV therapy for patients with COPD.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Toellner, Dr Hannah and Lowe, Dr David and Carlin, Dr Christopher and McDowell, Grace
Authors: McDowell, G., Sumowski, M., Toellner, H., Karok, S., O'Dwyer, C., Hornsby, J., Lowe, D. J., and Carlin, C. M.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:BMJ Open Respiratory Research
Publisher:BMJ Publishing Group
ISSN:2052-4439
ISSN (Online):2052-4439
Published Online:15 November 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in BMJ Open Respiratory Research 8(1): e000828
Publisher Policy:Reproduced under a Creative Commons License

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