Optimal NIV Medicare Access Promotion: Patients With Thoracic Restrictive Disorders

Gay, Peter C.; Owens, Robert L.; Wolfe, Lisa F.; Benditt, Joshua O.; Aboussouan, Loutfi S.; Coleman, John M.; Hess, Dean; Hill, Nicholas S.; Criner, Gerard J.; Branson, Richard D.; Celli, Bartolomé R.; MacIntyre, Neil R.; Sergew, Amen; Morgenthaler, Timothy I.; Malhotra, Atul; Berry, Richard B.; Johnson, Karin G.; Raphaelson, Marc; Mokhlesi, Babak; Won, Christine; Selim, Bernardo J.; Make, Barry J.; Sunwoo, Bernie Y.; Collop, Nancy A.; Patil, Susheel P.; Chediak, Alejandro D.; Olson, Eric J.; Vohra, Kunwar Praveen

doi:10.1016/j.chest.2021.05.075

Cited by 17 publications

(12 citation statements)

References 31 publications

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“…The workgroup incorporated and expanded positive screening impairments that would support referral for NIV in keeping with the recent recommendations of the American Thoracic Society. 50 Screening for respiratory impairment and referral for noninvasive respiratory support (NIV and cough assist) were combined into a single quality measure. This quality measure is intended to capture the most critical existing gap in identifying respiratory dysfunction and early initiation of NIV and cough assist if it is within the patient's care preferences.…”

Section: Resultsmentioning

confidence: 99%

“…This quality measure is intended to capture the most critical existing gap in identifying respiratory dysfunction and early initiation of NIV and cough assist if it is within the patient's care preferences. 12,50 There is a persistent gap related to comprehensive respiratory care of patients with ALS, including pharmacologic therapies (inhalers and nebulization), devices (high-frequency chest wall oscillations, incentive respiratory training, lung volume recruitment, suction machine, nebulizer, mouthpiece ventilation, etc), and appropriate respiratory therapist, physician, and technical support. 12,51 Although important, at present, the work group felt capturing all these elements would not be feasible in our current quality measure data collection.…”

Section: Resultsmentioning

confidence: 99%

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Amyotrophic Lateral Sclerosis Quality Measurement Set 2022 Update

et al. 2023

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The estimated prevalence of amyotrophic lateral sclerosis (ALS) is approximately 5.2–7.9 people per 100,000 in the United States,1,2 with a worldwide ALS estimate of 4.42 per 1,000,000 population.3 Patients with ALS have progressive arm and leg weakness, speech, swallowing, and respiratory impairments, and frequent cognitive/behavioral dysfunction. Median tracheostomy-free survival from onset of weakness is 34.7 months, but progression rates vary substantially between individuals.4 Although pharmacologic treatment options remain limited, judicious use of noninvasive ventilation, adequate nutritional support, and multidisciplinary care serve as the background for a landscape that continues to evolve with increasing availability of neuroprotective treatments and targeted genetic therapies on both a clinical5 and research basis.6,7

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Amyotrophic Lateral Sclerosis Quality Measurement Set 2022 Update

et al. 2023

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“…In agreement with the ONMAP Technical Expert Panel recommendations, 100 we prescribe a home ventilator instead of a bilevel device for patients with neuromuscular disease who have a FVC or SVC < 30 predicted or have previously failed bilevel support. Additionally, we prescribe a home ventilator for most people who need home assisted ventilation longer than 10 hours a day; require peak inspiratory pressures above 25 cmH2O or supplemental oxygen above 2 L/min after normalization of PCO2; for patients with expected rapid progression of muscle weakness; and for those with a tracheostomy in place.…”

Section: Selecting a Respiratory Devicementioning

confidence: 88%

“…98 In 2021, the Optimal NIV Medicare Access Promotion (ONMAP) technical expert panel representing the American Thoracic Society, the American College of Chest Physicians, the American Association of Respiratory Care, and the American Academy of Sleep Medicine published consensus recommendations for updating CMS coverage criteria for noninvasive positive pressure ventilation devices. 99,100 Noteworthy among the recommendations are increasing the qualifying vital capacity threshold to <80% predicted if accompanied by respiratory symptoms, and acceptance of an end-tidal or transcutaneous PCO2 as a substitute for arterial puncture to document hypercapnia. Recommendations of the expert panel for thoracic restrictive diseases are detailed in Table 4.…”

Section: Indications For Initiation Of Nocturnal Noninvasive Ventilationmentioning

confidence: 99%

“…For people with chronic respiratory muscle weakness, we encourage initiation of home assisted ventilation when a patient meets any of the criteria recommended by the ONMAP panel 100 or as soon as insurance coverage is available thereafter. Early initiation of therapy may be particularly important for patients with ALS because considerable lead time is often required to optimize interface selection and device settings and to fully acclimate patients to assisted ventilation.…”

Section: Indications For Initiation Of Nocturnal Noninvasive Ventilationmentioning

confidence: 99%

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Practical Guide to Management of Long-Term Noninvasive Ventilation for Adults With Chronic Neuromuscular Disease

Hansen‐Flaschen

Ackrivo

2023

Respir Care

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Recent technological advances in respiratory support and monitoring have dramatically enhanced the utility of long-term noninvasive ventilation. Improvements in quality of life and prolonged survival at home have been demonstrated for several common chronic neuromuscular diseases. Many adults with progressive neuromuscular respiratory disease can now comfortably maintain normal ventilation at home to near total respiratory muscle paralysis without needing a tracheostomy. However, current practice in many communities falls short of that potential. Mastery of the new technology calls for detailed awareness of the respiratory cycle, expert knowledge of mechanical devices, facial interfaces, quantitative monitoring tools for home ventilation, and a willingness to stay current in a rapidly expanding body of clinical research. The depth and breadth of the expertise required to manage home assisted ventilation is giving rise to a new focused medical subspecialty in chronic respiratory failure at the interface between pulmonology, critical care, and sleep medicine. For clinicians seeking pragmatic "how to" guidance, this primer presents a comprehensive, physician-directed management approach to long-term noninvasive ventilation of adults with chronic neuromuscular respiratory disease. Bilevel devices, portable ventilators, ventilation modalities, terminology, and monitoring strategies are reviewed in detail. Building on that knowledge base, we present a step-by-step guide to initiation, refinement, and maintenance of home noninvasive ventilation that is tailored to patientcentered goals of therapy. The "quantitative" approach recommended here fully incorporates routine monitoring of home assisted ventilation using technologies that have only recently become widely available including cloud-based device telemonitoring and noninvasive measurements of blood gases. Strategies for troubleshooting and problem solving are included.

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