A new article discusses recent technological advances in respiratory support and monitoring that have dramatically enhanced the utility of long-term noninvasive ventilation. With these technological advances, 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, the authors present a step-by-step guide to initiation, refinement, and maintenance of home noninvasive ventilation that is tailored to patient-centered 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.
Here is the table of content of the document:
- PART I. DEVICES
Devices for home assisted ventilation
The assisted breathing cycle
Modes of assisted ventilation
Monitoring assisted ventilation
- PART II. MANAGEMENT
Indications for initiation of home noninvasive ventilation Initiation Phase
Adaptation and refinement phase
Maintenance phase
Diurnal ventilation
Tracheostomy
End of life respiratory care
- PART III. TROUBLESHOOTING AND PROBLEM SOLVING
Face mask discomfort
Excessive air leak
Excessive airway secretions
Upper airway resistance
Patient-ventilator asynchrony
Aerophagia
- Conclusion