Long-term mechanical ventilation. Guidelines for management in the home and at alternate community sites. Report of the Ad Hoc Committee, Respiratory Care Section, American College of Chest Physicians

OʼDonohue, Walter J.; Giovannoni, Rita M.; Goldberg, Allen I.; Keens, Thomas G.; Make, Barry J.; Plummer, Alan L.; Prentice, William

doi:10.1378/chest.90.1.1s

Cited by 50 publications

(25 citation statements)

References 40 publications

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“…There were 44 patients, 14 women and 30 men, with a mean age of 60z/x13 years in Group 1, and it consisted of patients previously assessed in our Center (historical controls). In Group 2 there were 20 ALS patients, 8 women and 12 men, with a mean age of 56z/x11 years, with more than 15 nocturnal respiratory events/ hour, 16 but with normal blood gases. These patients were recruited prospectively.…”

Section: Methodsmentioning

confidence: 99%

Nocturnal pulse oximetry: a new approach to establish the appropriate time for non‐invasive ventilation in ALS patients

Pinto,

de Carvalho,

Evangelista

et al. 2003

Amyotrophic Lateral Sclerosis and Other Motor Neuron Disorders

105

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Previous studies have supported non-invasive ventilation (NIV) in amyotrophic lateral sclerosis (ALS), indicating that it prolongs survival. However, criteria for the use of NIV are yet to be defined. The aim of the present study was to evaluate the potential use of nocturnal pulse oximetry (NPO) as a tool for determining the most appropriate time at which to initiate NIV in ALS patients. We conducted a prospective, comparative, historical-controlled clinical study of 64 consecutive ALS patients. Group 1 (historical control group) comprised 44 patients, 14 women and 30 men, with a mean age of 60+/-13 years, in whom we used NIV after detecting early signs of diurnal respiratory insufficiency (RI). Group 2 had 20 ALS patients, 8 women and 12 men, with a mean age of 56+/-11 years, for whom we started NIV after detecting more than 15 periods of nocturnal desaturation/hour by NPO. All patients were periodically evaluated with Norris spinal and bulbar scores, respiratory function tests (RFT) and NPO at three month intervals for one year. They were subsequently followed until death or loss of autonomy from the ventilator. We compared survival time or time to loss of autonomy from the ventilator between both groups. Survival was longer in Group 2 (p<0.002). We concluded that NPO is a valuable screening test to establish the need for NIV. Our results also suggest that the early diagnosis of RI and the early use of NIV increase patient compliance with NIV.

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Section: Methodsmentioning

confidence: 99%

Nocturnal pulse oximetry: a new approach to establish the appropriate time for non‐invasive ventilation in ALS patients

Pinto,

de Carvalho,

Evangelista

et al. 2003

Amyotrophic Lateral Sclerosis and Other Motor Neuron Disorders

105

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“…A resurgence of interest has occurred in association with the increased number of patients who remain in the ICU simply because of their ventilator dependence. Advances in ventilator technology, improvements in home care services and pressures to reduce institutional costs have contributed to the increasing numbers of people being considered for HMV both in North America and in Europe (2,(7)(8)(9)(10).…”

Section: Objectivementioning

confidence: 99%

“…As an important alternative to institutional care, HMV has improved the cost effectiveness of health care for the users by decreasing their morbidity and improving their health-related quality of life (4,5,7).…”

Section: Résultatsmentioning

confidence: 99%

Long Term Follow‐up of Ventilated Patients with Thoracic Restriction and Neuromuscular Disease

Brooks

Rosie²,

Mousseau³

et al. 2002

Canadian Respiratory Journal

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OBJECTIVE: To evaluate the long term effects of home mechanical ventilation (HMV) on pulmonary function, nighttime gas exchange, daytime arterial blood gases, sleep architecture and functional exercise capacity (6 min walk). Patients with respiratory failure attributable to thoracic restrictive disease (TRD) (kyphoscoliosis) or neuromuscular disease (NMD) were assessed, ventilated, trained and followed in a dedicated unit for the care of patients requiring long term ventilation.DESIGN: All patients admitted for home ventilation training since 1988 were reviewed. Measurements of lung function, gas exchange during wakefulness and sleep, as well as functional exercise capacity, were recorded before and immediately after the establishment of HMV. Measurements were repeated one to two years, five years and eight to 10 years later.PATIENTS: Seventy-four individuals with TRD or NMD who completed the home ventilation training program and continued with HMV during all or part of the day for at least one year were studied.RESULTS: Forty patients had TRD. The characteristics of these patients were (mean ± SE) as follows: age 58±2.4 years; vital capacity (VC) 27%±1.6% predicted, forced expiratory volume in 1 s (FEV1) 25%±1.5% predicted; FEV1/forced VC (FVC) 78%±1.8%. Thirty-four patients had NMD. The characteristics of these patients were as follows: age 44±3.1 years; VC 41%±4.9% predicted, FEV144±5.3% predicted; FEV1/FVC 83%±4.2%. There was a significant improvement in distance walked in 6 min (maximum change 51.2 m in patients with NMD and 93.0 m in patients with TRD), daytime partial pressure of arterial carbon dioxide (maximum change 12.9 mmHg in patients with NMD and 10.4 mmHg in patients with TRD) and nighttime partial pressure of arterial carbon dioxide (maximum change 11.7 mmHg in patients with NMD and 18.0 mmHg in patients with TRD) over time (P≤0.004). Ventilation resulted in an improvement in partial pressure of arterial oxygen in patients with TRD (68.1±2.8 mmHg to 80.1±3.5 mmHg) and in patients with NMD (52.9±1.7 mmHg to 65.3±2.1 mmHg), although the change was not statistically significant in patients with NMD (P=0.001 in patients with TRD; P=0.105 in patients with NMD). The improvement after ventilation was maintained over several years. Sleep efficiency (75%±18%, 79%±2.2%), the arousal index (13.4±13 events/h, 28.2±17 events/h) and the apnea-hypopnea index (10.1±11.3 events/h, 13.9±9.5 events/h) did not change with time in either patients with TRD or patients with NMD, respectively (P≥0.5).CONCLUSIONS: HMV was associated with sustained, long term improvements in nighttime and daytime gas exchange in patients with TRD and NMD. Function exercise capacity increased in patients with TRD and in a subgroup of ambulatory patients with NMD. In patients with TRD, these improvements were maintained for up to 10 years after HMV was established.

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“…It should be considered that home is always the preferred location for these patients because it is less expensive than hospital or long-term facilities, and it maximizes their quality of life [95]. Nevertheless, very few publications have addressed this aspect in recent years [91, 96]. Limited data are available on health care costs for HMV patients; higher costs are associated with more severe disease [97] and with the use of HMV in patients with ALS [33].…”

Section: Home Care Management Of Long-term Noninvasive Ventilationmentioning

confidence: 99%

Long-Term Ventilation in Neuromuscular Patients: Review of Concerns, Beliefs, and Ethical Dilemmas

Crimi

Pierucci²,

Carlucci

et al. 2019

Respiration

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Background: Noninvasive mechanical ventilation (NIV) is an effective treatment in patients with neuromuscular diseases (NMD) to improve symptoms, quality of life, and survival. Summary: NIV should be used early in the course of respiratory muscle involvement in NMD patients and its requirements may increase over time. Therefore, training on technical equipment at home and advice on problem solving are warranted. Remote monitoring of ventilator parameters using built-in ventilator software is recommended. Telemedicine may be helpful in reducing hospital admissions. Anticipatory planning and palliative care should be carried out to lessen the burden of care, to maintain or withdraw from NIV, and to guarantee the most respectful management in the last days of NMD patients’ life. Key Message: Long-term NIV is effective but challenging in NMD patients. Efforts should be made by health care providers in arranging a planned transition to home and end-of-life discussions for ventilator-assisted individuals and their families.

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Long-term mechanical ventilation. Guidelines for management in the home and at alternate community sites. Report of the Ad Hoc Committee, Respiratory Care Section, American College of Chest Physicians

Cited by 50 publications

References 40 publications

Nocturnal pulse oximetry: a new approach to establish the appropriate time for non‐invasive ventilation in ALS patients

Nocturnal pulse oximetry: a new approach to establish the appropriate time for non‐invasive ventilation in ALS patients

Long Term Follow‐up of Ventilated Patients with Thoracic Restriction and Neuromuscular Disease

Long-Term Ventilation in Neuromuscular Patients: Review of Concerns, Beliefs, and Ethical Dilemmas

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