Modern aspects of organizing respiratory therapy at home

Perepelitsa S.A.

Rationale: Chronic respiratory failure is becoming an increasingly serious problem for patients with incurable diseases, the progression of which dictates the need for respiratory therapy. Many specialists face the problem of identifying early symptoms of respiratory failure progression, diagnosing its degree, prescribing respiratory therapy and organizing continuous monitoring of vital functions at home. Both infants and adults of various age groups need such treatment. The list of diseases that require respiratory therapy for a long time or for life is quite large. In young children, this may include bronchopulmonary dysplasia, consequences of hypoxic-hemorrhagic damage to brain structures, congenital malformations and genetic diseases. At an older age, neurodegenerative and neuromuscular diseases may manifest, as well as other problems associated with the severe course of acute neuroinfections and hypoxic-traumatic damage to the central nervous system, oncological diseases, consequences of acute cerebrovascular accident, injuries, critical blood loss, cardiopulmonary resuscitation. The most promising method is non-invasive ventilation of the lungs, which allows achieving the set therapeutic goals and reducing the frequency of complications. The appointment of this type of treatment requires a different approach to these patients. The doctor should daily assess the patient’s condition, the degree of synchronization with the device, the presence of signs of obstruction of the upper respiratory tract and air leakage. Continuous telemonitoring of body functions is important for such patients. The article discusses the organization of respiratory therapy, options for its use in patients with various diseases.

1. Amin R, Sayal P, Syed F, et al. Pediatric long- term home mechanical ventilation: twenty years of follow- up from one Canadian center. Pediatr Pulmonol. 2014; 49 (8): 816-824. doi: 10.1002/ppul.22868.

2. Sobotka SA, Gaur DS, Goodman DM, et al. Pediatric patients with home mechanical ventilation: the health services landscape. Pediatr Pulmonol. 2018; 54 (1): 40-46. 10.1002/ppul.24196.

3. Foster CC, Kwon S, Shah AV, et al. At-home end-tidal carbon dioxide measurement in children with invasive home mechanical ventilation. Pediatr Pulmonol. 2022; 57(11): 2735-2744. doi: 10.1002/ppul.26092.

4. [URL].

5. Maquilón C, Antolini M, Valdés N, et al. Results of the home mechanical ventilation national program among adults in Chile between 2008 and 2017. BMC Pulm Med. 2021; 21(1): 394. doi: 10.1186/s12890-021-01764-4.

6. Janssens J-P, Michel F, Schwarz EI, et al. Long-Term Mechanical Ventilation: Recommendations of the Swiss Society of Pulmonology. Respiration. 2020; 99: 867-902. doi:10.1159/000510086.

7. Borel J-C, Palot A, Patout M. Technological advances in home non-invasive ventilation monitoring: Reliability of data and effect on patient outcomes. Respirology. 2019; 24(12): 1143-1151. doi: 10.1111/resp.13497.

8. Schäfer H. Home mechanical ventilation MMW Fortschr Med. 2020; 162 (7): 41-50. doi: 10.1007/s15006-020-0012-z.

9. Hayes DJr., Wilson KC, Krivchenia K, et al. Home oxygen therapy for children. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2019; 199: e5-e23. doi: 10.1164/rccm.201812-2276ST.

10. Karkashadze GA, Anikin AV, Zimina EP, et al. Recent Information on the Pathogenesis and Treatment of Hypoxic-Ischemic Brain Lesions in Newborns. Pediatric pharmacology. 2016; 13 (5): 452-467. (In Russ.) doi: 10.15690/pf.v13i5.1641.

11. Schulzke SM, Stoecklin B. Update on ventilatory management of extremely preterm infants—A Neonatal Intensive Care Unit perspective. Paediatr Anaesth. 2022; 32(2): 363-371. doi: 10.1111/pan.14369.

12. Kovner EV, Ishutin AA, Zolotareva LS. Experience of the palliative care hospital based on the State Autonomous Healthcare Institution of the Moscow Region “Moscow Regional Hospice (for Children)”. Palliative Medicine and Rehabilitation. 2022; 2: 49-53. (In Russ.)

13. Minaeva NV, Islamova RI, Bazhenova MI. Outpatient Liaison Palliative Care for Children: Two Years’ Experience of Non-profit Charitable Organization. Current Pediatrics. 2020; 19(1): 46-56. (In Russ.) doi: 10.15690/vsp.v19i1.2085.

14. Liu Y, Li T, Shi L. Long-term home mechanical ventilation using a noninvasive ventilator via tracheotomy in patients with myasthenia gravis: a case report and literature review. Ther Adv Respir Dis. 2023; 17: 17534666231165914. doi: 10.1177/17534666231165914.

15. Arnal J-M, Oranger M, Gonzalez-Bermejo J. Monitoring Systems in Home Ventilation. J Clin Med. 2023; 12(6): 2163. doi: 10.3390/jcm12062163.

16. Lloyd-Owen SJ, Donaldson GC, Ambrosino N, et al. Patterns of home mechanical ventilation use in Europe: results from the Eurovent survey. Eur Respir J. 2005; 25(6): 1025-31. doi: 10.1183/09031936.05. 00066704.

17. Köhler D. Explosive increase in home nursing care for ventilated and tracheotomized patients. Dtsch Med Wochenschr. 2019; 144(4): 1-4. doi: 10.1055/a-0677-3294.

18. Rousseau S. Position paper on the complex outpatient care of tracheotomized patients with and without ventilation after long-term intensive care. Pneumologie. 2017; 71(4): 204-6. doi: 10.1055/s-0043-104028.

19. Windisch W, Dreher M, Geiseler J, et al. Guidelines for Non-Invasive and Invasive Home Mechanical Ventilation for Treatment of Chronic Respiratory Failure – Update 2017. Pneumologie. 2017; 71(11):722-795. doi: 10.1055/s-0043-118040.

20. van den Biggelaar RJM, Hazenberg A, Cobben NAM, et al. Home mechanical ventilation: the Dutch approach. Pulmonology. 2022; 28(2): 99-104. doi: 10.1016/j.pulmoe. 2021.11.001.

21. Federal Law of Russian Federation №323 «Ob osnovakh okhrany zdorov’ya grazhdan v Rossiyskoy Federatsii”, dated 2011 November 21, red. ot 29.05.2019. (In Russ.)

22. Order of the Ministry of health of the Russian Federation and the Ministry of labor and social protection № 345n/372n «Ob utverzhdenii Polozheniya ob organizatsii okazaniya palliativnoy meditsinskoy pomoshchi, vklyuchaya poryadok vzaimodeystviya meditsinskikh organizatsiy, organizatsiy sotsial’nogo obsluzhivaniya i obshchestvennykh ob”yedineniy, inykh nekommercheskikh organizatsiy, osushchestvlyayushchikh svoyu deyatel’nost’ v sfere okhrany zdorov’ya”, dated 2019 May 31. (In Russ.)

23. Mador MJ. Identifying an Important Ingredient for Safe Discharge to Home Oxygen Therapy: The Respiratory Therapist and the RIsOTTO Study. Respir Care. 2021; 66(2): 347-348. doi: 10.4187/respcare.08832.

24. Kim HI, Cho JH, Park SY, et al. Home mechanical ventilation use in South Korea based on National Health Insurance Service Data. Respir Care. 2019; 64(5): 528-535. doi: 10.4187/respcare.06310.

25. Carmona H, Graustein AD, Benditt JO. Chronic Neuromuscular Respiratory Failure and Home Assisted Ventilation. Annu Rev Med. 2023; 74: 443-455. doi: 10.1146/annurev-med-043021-013620.

26. Howard ME, Piper AJ, Stevens B, et al. A randomised controlled trial of CPAP versus non-invasive ventilation for initial treatment of obesity hypoventilation syndrome. Thorax. 2017; 72: 437-44. doi:10.1136/thoraxjnl-2016-208559

27. Pierucci P, Crimi C, Carlucci A, et al. REINVENT: ERS International survey on REstrictive thoracic diseases IN long term home noninvasive VENTilation. ERJ Open Res. 2021; 7(2): 00911-2020. doi: 10.1183/23120541. 00911-2020.

28. Heiman-Patterson TD, Cudkowicz ME, De Carvalho M, et al. Understanding the use of NIV in ALS: results of an international ALS specialist survey. Amyotroph. Lateral Scler. Frontotemporal Degener. 2018. 19(5–6): 331-341. doi: 10.1080/21678421.2018.1457058.

29. Dorst J, Ludolph AC. Non-invasive ventilation in amyotrophic lateral sclerosis. Ther. Adv. Neurol. Disord. 2019; 12: 1756286419857040. doi: 10.1177/1756286419857040.

30. Howard ME, Ridgers A. Implementing non-invasive ventilation at home: the frontier for chronic respiratory failure? Thorax. 2023; 78(1): 7-8. doi: 10.1136/thorax-2022-219480.

31. Murphy PB, Patout M, Arbane G, et al. Cost-effectiveness of outpatient versus inpatient non-invasive ventilation setup in obesity hypoventilation syndrome: the OPIP trial. Thorax 2023; 78: 16-23. doi: 10.1136/thorax-2021-218497.

32. Murphy PB, Rehal S, Arbane G, et al. Effect of home noninvasive ventilation with oxygen therapy vs. oxygen therapy alone on hospital readmission or death after an acute COPD exacerbation. A randomized clinical trial. JAMA. 2017; 317(21): 2177-2186. doi: 10.1001/jama.2017.4451.

33. Sørensen JS, Frost HM, Storgaard LH, et al. Home-based respiratory support. Ugeskr Laeger. 2024; 186(14): V09230613. doi: 10.61409/ V09230613.

34. Struik FM, Lacasse Y, Goldstein RS, et al. Nocturnal noninvasive positive pressure ventilation in stable COPD: A systematic review and individual patient data meta-analysis. Respir. Med. 2014; 108(2): 329-337. doi: 10.1016/j.rmed.2013.10.007.

35. Georges M, Nguyen-Baranoff D, Griffon L, et al. Usefulness of transcutaneous PCO2 to assess nocturnal hypoventilation in restrictive lung disorders. Respirology. 2016; 21(7): 1300-1306. doi: 10.1111/resp.12812.

36. Yoshizaki A, Nagano T, Izumi S, et al. Characteristics of the nocturnal desaturation waveform pattern of SpO2 in COPD patients: An observational study. Respir. Res. 2021; 22(1): 276. doi: 10.1186/s12931-021-01868-9.

37. Georges M, Rabec C, Monin E, et al. Monitoring of noninvasive ventilation: Comparative analysis of different strategies. Respir. Res. 2020; 21(1): 324. doi: 10.1186/s12931-020-01586-8.

38. Boentert M, Glatz C, Helmle C, et al. Prevalence of sleep apnoea and capnographic detection of nocturnal hypoventilation in amyotrophic lateral sclerosis. J. Neurol. Neurosurg. Psychiatry. 2018; 89(4): 418-424. doi: 10.1136/jnnp-2017-316515.

39. Janssens J-P, Cantero C, Pasquina P, et al. Monitoring Long Term Noninvasive Ventilation: Benefits, Caveats and Perspectives. Front. Med. 2022; 9: 874523. doi: 10.3389/fmed.2022.874523.

40. Luján M, Lalmolda C, Ergan B. Basic Concepts for Tidal Volume and Leakage Estimation in Non-Invasive Ventilation. Turk. Thorac. J. 2019; 20 (20): 140–146. doi: 10.5152/TurkThoracJ.2018.177.

41. Alvarez RF, Rabec C, Cuadrado GR, et al. Monitoring Noninvasive Ventilation in Patients with Obesity Hypoventilation Syndrome: Comparison between Ventilator Built-in Software and Respiratory Polygraphy. Respiration. 2017; 93(3): 162-169. doi: 10.1159/000454954.

42. Mojoli F, Pozzi M, Orlando A, et al. Timing of inspiratory muscle activity detected from airway pressure and flow during pressure support ventilation: The waveform method. Crit. Care. 2022; 26(1): 32. doi: 10.1186/s13054-022-03895-4.

43. Hwang D, Chang JW, Benjafield AV, et al. Effect of Telemedicine Education and Telemonitoring on Continuous Positive Airway Pressure Adherence. The Tele-OSA Randomized Trial. Am. J. Respir. Crit. Care Med. 2018; 197(1): 117-126. doi: 10.1164/rccm.201703-0582OC.

44. Pépin J-L, Jullian-Desayes I, Sapène M, et al. Multimodal Remote Monitoring of High Cardiovascular Risk Patients with OSA Initiating CPAP. Chest. 2019; 155(4): 730-739. doi: 10.1016/j.chest.2018.11.007.

45. Hoet F, Libert W, Sanida C, et al. Telemonitoring in continuous positive airway pressure-treated patients improves delay to first intervention and early compliance: A randomized trial. Sleep Med. 2017; 39: 77-83. doi: 10.1016/j.sleep.2017.08.016.