Background The UK HOT-HMV-COPD study confirms benefit from home NIV in hypercapnic severe COPD patients. Home NIV provision presents clinical and service challenges, with repeated attendances and elective admission(s) unrealistic for COPD patients. 2-way remote monitoring and volume assured pressure support with auto-titrating EPAP (auto-NIV) modes offer prospects for realistic NIV optimisation and rationalised follow up.
Methods 46 patients with chronic hypercapnic COPD commenced remote-monitored home NIV in iVAPS-autoEPAP mode (Lumis, Airview, ResMed) between Feb-17 – Jan-18. Admission-free survival was compared with a cohort of COPD patients who survived an episode requiring acute-NIV, prior to home NIV service adoption.
Results Day-case NIV initiation was possible in 15/46 patients; 29 patients commenced NIV during index acute admission, including 7 patients as outreach to regional base hospitals. 36/46 continued NIV in volume-assured mode, 10 were switched to ST mode. Auto-EPAP component was discontinued in 18 patients. Follow up was individualised, typically requiring 6 data reviews, 2 telephone consultations and 1 remote prescription change. 15 patients required additional domiciliary nurse visit and 10 required additional day-case review to consolidate therapy. 11 patients were ultimately intolerant of home NIV despite all support; remote monitoring data justified ventilator retrieval. Median decrease in bicarbonate of 4.9 mmol/L (p<0.0151) and PCO2 2.2 kPa (p<0.032) confirmed control of hypoventilation. Median time to re-admission or death in patients who continued optimised home NIV was 28 weeks, vs 12 weeks in historical acute NIV cohort.
Conclusions Remote monitored auto-NIV facilitates treatment uptake, optimisation of home NIV and control of hypoventilation in patients with severe COPD. Admission-free survival improved from that projected from historical cohort, mirroring RCT outcomes.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.