Although cost comparisons across studies could not be made due to the inconsistent manner in which data were reported, evidence demonstrated that care provided by RTs yielded both direct and indirect cost reductions, which were achieved through protocol utilization, specialized expertise, and autonomous decision making. The care provided was consistent with care provided by other disciplines. It is critical for the respiratory care profession to highlight key clinical practice areas for future research, to establish uniform reporting measures for outcomes, and to foster the development of future respiratory care researchers to affirm the value that respiratory therapists add to patient care.
For patients with chronic obstructive pulmonary disease (COPD), an increase in exercise tolerance and ability to perform activities of daily living (ADLs) can mean an improved quality of life with fewer exacerbations and lower health care expenses. We evaluated a wearable, noninvasive open ventilation (NIOV) system designed to enhance exercise capacity and increase mobility. Patients with stable, oxygen-dependent COPD were recruited for this prospective, open-label, crossover study. Inclusion criteria included supplemental oxygen use, elevated dyspnea score, and the ability to perform ADLs. Patients performed a selected ADL for as long as tolerable while using standard oxygen therapy. Following a rest period, the same ADL was repeated using the NIOV system. ADL endurance time, oxyhemoglobin saturation measured by pulse oximeter ( SpO), dyspnea, fatigue, and discomfort scores were recorded. Thirty patients were enrolled and 29 patients completed the study. Mean ADL endurance increased by 85% (13.4 vs. 7.2 min) using NIOV compared with oxygen therapy (p<0.0001). Mean SpO was significantly higher during ADLs using NIOV versus oxygen therapy (p<0.0001). Median dyspnea, fatigue, and discomfort scores were significantly lower using NIOV during ADLs compared to oxygen therapy (p<0.01). No device-related adverse events were observed. This study demonstrated that a novel, portable noninvasive open ventilation system can improve ADL performance in the home setting. Compared to standard oxygen therapy, the NIOV system provided statistically and clinically significant increases in ADL endurance time and oxygenation, while decreasing dyspnea, fatigue, and discomfort. The NIOV system appears to offer a practical option for increasing activity and exercise tolerance in oxygen-dependent patients with COPD.
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