Introduction The prevalence of conditions requiring nocturnal breathing support is increasing. 2-way remote monitoring via a cloud based system provides access to home non-invasive ventilation (NIV) data, highlights therapy issues and facilitates prescription changes to optimise NIV and potentially rationalise patient follow up. Remote-adjustable volume-assured NIV modes with auto-EPAP and intelligent backup rates offer prospects for improved NIV titration. We have adopted these emerging technologies with aim of improving patient outcomes and service efficiency. Interrogation of remote monitoring NIV data will provide insights to the utility of new NIV modes.

Methods Between February and June 2017 67 patients (26 OHV, 21 COPD, 20 other cause hypoventilation) who had clinical indications for home NIV were commenced on iVAPS with auto-EPAP and intelligent backup rate mode NIV (Lumis, ResMed) with remote monitoring (Airview, ResMed) and their data was retrospectively reviewed.

Results 31 patients commenced NIV as a day-case rather than as inpatients (our previous service model), saving 93 occupied bed days. Patients required on average 3 data reviews and 1 telephone consultation. Remote prescription change – eg capping of pressures or adjustment of iVAPS targets to achieve symptomatic benefit or tolerance – was required in 38 patients, with 20 requiring more than 1 change. Adverse monitoring findings triggered beneficial early follow up day-case review in 12 patients. The majority of patients realised good NIV usage and benefit (based on standard monitoring parameters) after optimisation; 6 patients discontinued NIV use despite treatment adjustments. Disease-specific patterns of iVAPS pressure support provision with volume assured mode were noted. Auto-EPAP was poorly tolerated in COPD patients.

Conclusion 2-way remote monitoring highlights NIV therapy issues, allowing early remote or daycase troubleshooting and optimisation, which should translate to improved treatment outcomes. Remote monitoring facilitates day-case initiation, saving occupied bed days and outpatient visits vs our previous service model. 2-way monitoring identifies intractable non-compliant patients, expediting ventilator recovery. Disease-specific iVAPS provision patterns have been identified which will provide novel management and pathophysiological insights.