Monitoring of noninvasive ventilation: comparative analysis of different strategies
- PDF / 1,566,674 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 17 Downloads / 196 Views
Open Access
RESEARCH
Monitoring of noninvasive ventilation: comparative analysis of different strategies Marjolaine Georges1,2,3,7* , Claudio Rabec1, Elise Monin1, Serge Aho2,4, Guillaume Beltramo1, Jean‑Paul Janssens5† and Philippe Bonniaud1,2,6†
Abstract Background: Noninvasive ventilation (NIV) represents an effective treatment for chronic respiratory failure. However, empirically determined NIV settings may not achieve optimal ventilatory support. Therefore, the efficacy of NIV should be systematically monitored. The minimal recommended monitoring strategy includes clinical assessment, arterial blood gases (ABG) and nocturnal transcutaneous pulsed oxygen saturation ( SpO2). Polysomnography is a theoreti‑ cal gold standard but is not routinely available in many centers. Simple tools such as transcutaneous capnography ( TcPCO2) or ventilator built-in software provide reliable informations but their role in NIV monitoring has yet to be defined. The aim of our work was to compare the accuracy of different combinations of tests to assess NIV efficacy. Methods: This retrospective comparative study evaluated the efficacy of NIV in consecutive patients through four strategies (A, B, C and D) using four different tools in various combinations. These tools included morning ABG, nocturnal SpO2, TcPCO2 and data provided by built-in software via a dedicated module. Strategy A (ABG + nocturnal SpO2), B (nocturnal SpO2 + TcPCO2) and C ( TcPCO2 + builtin software) were compared to strategy D, which combined all four tools (NIV was appropriate if all four tools were normal). Results: NIV was appropriate in only 29 of the 100 included patients. Strategy A considered 53 patients as appropri‑ ately ventilated. Strategy B considered 48 patients as appropriately ventilated. Strategy C misclassified only 6 patients with daytime hypercapnia. Conclusion: Monitoring ABG and nocturnal SpO2 is not enough to assess NIV efficacy. Combining data from ventila‑ tor built-in software and TcPCO2 seems to represent the best strategy to detect poor NIV efficacy. Trial registration Institutional Review Board of the Société de Pneumologie de Langue Française (CEPRO 2016 Georges) Keywords: Non-invasive ventilation, Monitoring, Transcutaneous capnography, Nocturnal pulse oximetry, Bi-level positive airway pressure, Respiratory failure Background Non-invasive ventilation (NIV) is recognized as an effective treatment of chronic hypercapnic respiratory failure (CHRF) [1]. Due to growing evidence of NIV efficacy in a *Correspondence: marjolaine.georges@chu‑dijon.fr † Jean-Paul Janssens and Philippe Bonniaud contributed equally to this work 1 Department of Pulmonary Medicine and Intensive Care Unit, University Hospital, Dijon, France Full list of author information is available at the end of the article
broad range of indications as well as increasing availability of high performance and user-friendly home ventilators, the number of patients receiving NIV at home has been regularly increasing over the past 30 years [2–4]. When NIV is ini
Data Loading...
