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Using domiciliary non-invasive ventilator data downloads to inform clinical decision-making to optimise ventilation delivery and patient compliance
  1. Stephanie K Mansell1,2,
  2. Steven Cutts1,
  3. Isobel Hackney1,
  4. Martin J Wood3,
  5. Kevin Hawksworth3,
  6. Dean D Creer2,
  7. Cherry Kilbride1,4 and
  8. Swapna Mandal2
  1. 1Therapies Department, Royal Free London NHS Foundation Trust, London, UK
  2. 2Department of Thoracic Medicine, Royal Free London NHS Foundation Trust, London, UK
  3. 3Renaissance Research, Darlington, UK
  4. 4Department of Clinical Sciences, Brunel University London, London, UK
  1. Correspondence to Stephanie K Mansell; stephanie.mansell1{at}nhs.net

Abstract

Introduction Ventilation 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).

Methods A 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.

Results Analysis 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).

Conclusion Ventilator 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.

  • Non-invasive Ventilation
  • Software
  • Technology

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Twitter @skmansell

  • Contributors SKM and DDC conceived the idea for the project. SC and IH collected and inputted the data. KH and MW conducted the data analysis. SKM, SC, IH, MJW, KH, CK and SM were involved in the development of the manuscript.

  • Funding This project was partially funded by Philips Respironics. Funding was provided for data entry and statistical analysis. Third party statisticians (MW and KH) conducted the statistical analysis. Philips Respironics were not involved in the study design.

  • Competing interests SKM and SC have received sponsorship from Philips Respironics for conference attendance. SKM has provided consultation and speaker services to Philips Respironics.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

  • Presented at European Respiratory Society Congress 2016

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