Long-Term Mechanical Ventilation: Recommendations of the Swiss Society of Pulmonology

Abstract

Long-term mechanical ventilation is a well-established treatment for chronic hypercapnic respiratory failure (CHRF). It is aimed at improving CHRF-related symptoms, health-related quality of life, survival, and decreasing hospital admissions. In Switzerland, long-term mechanical ventilation has been increasingly used since the 1980s in hospital and home care settings. Over the years, its application has considerably expanded with accumulating evidence of beneficial effects in a broad range of conditions associated with CHRF. Most frequent indications for long-term mechanical ventilation are chronic obstructive pulmonary disease, obesity hypoventilation syndrome, neuromuscular and chest wall diseases. In the current consensus document, the Special Interest Group of the Swiss Society of Pulmonology reviews the most recent scientific literature on long-term mechanical ventilation and provides recommendations adapted to the particular setting of the Swiss healthcare system with a focus on the practice of non-invasive and invasive home ventilation in adults.

Versorgungsqualität in der außerklinischen Beatmung

“…Neue Entwicklungen in den Modulen zur Vermittlung von erweiterten Kompetenzen zur Ausübung heil- ▶ Abb. 3 Versorgungsstrukturen im internationalen Vergleich bezogen auf die Initiierung und Kontrollen einer nicht invasiven Beatmung bei chronisch respiratorischer Insuffizienz [10,11,38,[48][49][50]. Klingshirn…”

“…Beispiele aus anderen europäischen Ländern machen deutlich, dass sowohl die Initiierung als auch die Kontrolle der Beatmung durchaus ambulant erfolgen kann 44 45 48 49 51 , insbesondere wenn es sich um eine nicht-invasive Beatmung handelt. Der Vorteil ambulanter Strukturen liegt nicht nur in der Vermeidung risikoreicher und belastender Transporte sondern ermöglicht auch eine Behandlung im vertrauten Umfeld der Betroffenen.…”

Monitoring Long Term Noninvasive Ventilation: Benefits, Caveats and Perspectives

“…The goals of long-term NIV (LTNIV) are to improve symptoms related to chronic hypercapnia and—when present—sleep-related breathing disorders (SRBD), to improve health-related quality of life (HRQL), decrease hospital admissions, correct hypoventilation and optimize SpO 2 in order to prevent the development of pulmonary hypertension and cor pulmonale, and improve survival ( 8 ). In several indications (chronic obstructive pulmonary diseases (COPD), amyotrophic lateral sclerosis (ALS), restrictive thoracic disorders), improvement of ABG and control of nocturnal hypoventilation are significantly associated with a better prognosis ( 9 – 13 ).…”

“…In order to achieve these goals, it is mandatory to ensure that: 1/ LTNIV improves daytime and nocturnal arterial blood gases, 2/ compliance to LTNIV is sufficient to have a significant physiological effect, 3/ LTNIV does not generate per se undesired respiratory events or side effects and discomfort, and 4/ HRQL and symptom scores improve over time. Guidelines usually recommend at least one annual elective assessment for patients under LTNIV: the frequency of evaluations depends however on the underlying pathology, its severity and rate of progression, and may be required as often as every 3 months ( 8 , 14 , 15 ).…”

Trigger performance of five pediatric home ventilators and one ICU ventilator depending on circuit type and system leak in a physical model of the lung

“…For home ventilation, single‐limb circuits are mostly used 30 because they are more manageable. To allow for adequate clearance of exhaled air the single‐limb circuit must have either an active expiratory valve (SL‐AEV) which opens during expiration or a passive exhalation port which can be either integrated in the circuit (SL‐PEP) or in the interface (vented mask) 31 . Each type promises different advantages.…”