Using domiciliary non-invasive ventilator data downloads to inform clinical decision-making to optimise ventilation delivery and patient compliance

• Published in: BMJ open respiratory research 2018-01, Vol.5 (1), p.e000238-e000238
• Main Authors: Mansell, Stephanie K, Cutts, Steven, Hackney, Isobel, Wood, Martin J, Hawksworth, Kevin, Creer, Dean D, Kilbride, Cherry, Mandal, Swapna
• Format: Article
• Language: English
• Subjects: Chronic obstructive pulmonary disease; Clinical decision making; Decision making; Modems; Non-Invasive Ventilation; Obesity; Oxygen therapy; Patient compliance; R&D; Research & development; Sleep; Software; Thorax; Ventilators
• ISSN: 2052-4439; 2052-4439
• DOI: 10.1136/bmjresp-2017-000238

IntroductionVentilation parameter data from patients receiving home mechanical ventilation can be collected via secure data cards and modem technology. This can then be reviewed by clinicians and ventilator prescriptions adjusted. Typically available measures include tidal volume (VT), leak, respiratory rate, minute ventilation, patient triggered breaths, achieved pressures and patient compliance. This study aimed to assess the potential impact of ventilator data downloads on management of patients requiring home non-invasive ventilation (NIV).MethodsA longitudinal within-group design with repeated measurements was used. Baseline ventilator data were downloaded, reviewed and adjustments made to optimise ventilation. Leak, VT and compliance data were collected for comparison at the first review and 3–7 weeks later. Ventilator data were monitored and amended remotely via a modem by a consultant physiotherapist between the first review and second appointment.ResultsAnalysis of data from 52 patients showed increased patient compliance (% days used >4 hours) from 90% to 96% (p=0.007), increased usage from 6.53 to 6.94 hours (p=0.211) and a change in VT(9.4 vs 8.7 mL/kg/ideal body weight, p=0.022). There was no change in leak following review of NIV prescriptions (mean (SD): 43 (23.4) L/min vs 45 (19.9)L/min, p=0.272).ConclusionVentilator data downloads, via early remote assessment, can help optimise patient ventilation through identification of modifiable factors, in particular interface leak and ventilator prescriptions. However, a prospective study is required to assess whether using ventilator data downloads provides value in terms of patient outcomes and cost-effectiveness. The presented data will help to inform the design of such a study.