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Background: For patients with chronic respiratory failure (CRF) who are treated with noninvasive positive pressure ventilation (NPPV), a little is known regarding the effects of low-intensity NPPV (LI-NPPV) on the clinical course of CRF and the frequency of adjustments in these patients. Objectives: This study investigated the effects of LI-NPPV on the clinical course of patients with CRF as compared with patients who were treated with conventional NPPV (C-NPPV) and determined how frequently NPPV was adjusted during therapy. Methods: Clinical data from 21 patients who received long-term NPPV were retrospectively analyzed. Patients were categorized into two groups based on the level of initial pressure support (PS): C-NPPV group (PS ≥ 10 cm H2O) and LI-NPPV group (PS < 10 cm H2O). Results: Patients in the LI-NPPV group had significantly more exacerbations of CRF (P < 0.05). There was no significant difference in the number of patients who required adjustments of NPPV settings between the two groups. There was no significant difference in PaCO2levels 1 month after the start of NPPV between the two groups; however, PaCO2levels were significantly lower after 1 year in the C-group (P < 0.001). Seventy-one percent of LI-NPPV patients and 43% of C-NPPV patients needed NPPV adjustments. Conclusions: Attention should be paid to CRF patients who are initially administered LI-NPPV; they should be carefully observed because they can develop more exacerbations of CRF than patients undergoing C-NPPV. If possible, higher initial PS should be administered to prevent CRF exacerbations.

We report the case of an 18-month-old infant with severe serotype 3 adenovirus pneumonia, exceptionally associated with hemophagocytic syndrome. Treatment included cidofovir and mechanical ventilation for 13 days. The child developed chronic respiratory insufficiency due to bronchiectasis and bronchiolitis obliterans. [ABSTRACT FROM AUTHOR]

Home oxygen therapy (HOT) is an important treatment for patients with chronic respiratory diseases. Recently, telemonitoring of HOT has been become available. In the present study, we examined whether telemonitoring of HOT could improve health-related quality of life (HRQOL). Twelve patients receiving HOT participated in this study. The oxygen flow rates, use of the oxygen concentrator, and the values of percutaneous arterial oxygen saturation measured by each patient with a pulse oximeter were checked using a telemonitoring system for a period of one month. Interventions based on the results obtained were carried out in order to optimize oxygen use in this patient cohort. We evaluated the results of the SF-36 questionnaire before the initiation of telemonitoring and at 3 months after completion of the study. We identified significant improvements in SF-36 sub-scores after completion of this intervention. We conclude that telemonitoring may be a useful method to improve HRQOL. [ABSTRACT FROM AUTHOR]

Background: High-flow nasal cannula (HFNC) is increasingly used in patients with acute exacerbation of COPD (AECOPD). We aimed to confirm whether the baseline bicarbonate is an independent predictor of outcomes in patients with hypercapnic AECOPD receiving HFNC., Methods: This was a secondary analysis of a multicentre randomised trial that enrolled 330 patients with non-acidotic hypercapnic AECOPD supported by HFNC or conventional oxygen treatment (COT). We compared the length of stay (LOS) in hospital and the rate of non-invasive positive pressure ventilation (NPPV) use according to baseline bicarbonate levels using the log-rank test or Cox proportional hazard model., Results: In the high bicarbonate subgroup (n = 165, bicarbonate 35.0[33.3-37.9] mmol/L, partial pressure of arterial carbon dioxide [PaCO 2 ] 56.8[52.0-62.8] mmHg), patients supported by HFNC had a remarkably prolonged LOS in hospital when compared to COT (HR 1.59[1.16-2.17], p = 0.004), whereas patients in the low bicarbonate subgroup (n = 165, bicarbonate 28.8[27.0-30.4] mmol/L, PaCO2 48.0[46.0-50.0] mmHg) had a comparable LOS in hospital regardless of respiratory support modalities. The rate of NPPV use in patients with high baseline bicarbonate level was significantly higher than that in patients with low baseline bicarbonate level (19.4 % vs. 3.0 %, p < 0.0001). Patients with high bicarbonate level in HFNC group had a lower rate of NPPV use compared to COT group (15.4 % vs. 23.0 %, p = 0.217)., Conclusions: Among patients with non-acidotic hypercapnic AECOPD with high baseline bicarbonate level, HFNC is significantly associated with a prolonged LOS in hospital, which may be due to the reduced escalation of NPPV treatment., Trial Registration: clinicaltrials.gov (NCT03003559)., Competing Interests: Declaration of competing interest All authors declare no conflicts of interest., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The Long-Term Oxygen Therapy (LTOT) is a fundamental part of the therapy of chronic respiratory failure in the pneumological patient. Both the latest 2004 AIPO guidelines and the numerous national and international guidelines that have followed over the years have had as their cornerstones two works dating back to the '80s in which it was demonstrated, on a relatively small number of patients, the effectiveness of the LTOT in improving the survival of subjects with Chronic Obstructive Pulmonary Disease (COPD). On the other hand, however, the issue of LTOT in patients with moderate or latent hypoxemia is quite controversial because there is a certain discrepancy between the scientific works (often against) and the proposed international guidelines (often in favor). Taking also into consideration the significant economic impact of the LTOT, equal to more than 15% of the annual direct costs for COPDs 1, the problem of its use becomes stringent. Hence the need for a review of the literature data, from 2004 to today, in order to update the LTOT recommendations and to highlight the criticalities in the use of the LTOT in those cases where its indications are not supported by solid scientific evidence but which are still present in numerous guidelines or address documents proposed in the literature. [ABSTRACT FROM AUTHOR]

Home oxygen therapy (HOT), also known as long-term oxygen therapy, is prescribed to patients with chronic respiratory failure (CRF) due to advanced respiratory diseases, as it has been shown to improve the prognosis of patients with chronic obstructive pulmonary disease (COPD). However, the therapeutic impact of HOT does not fully reflect the "socialization" of patients, which is one of the final goals of "comprehensive pulmonary rehabilitation", proposed by the Japanese Respiratory Society. Since working is one form of socialization, we evaluated a 55-yr-old worker prescribed with HOT for the management of advanced COPD to elucidate and assess the social barriers experienced by HOT users. This case demonstrates a variety of factors affecting patients, respiratory physicians, occupational physicians, and management teams, which prevents patients from working. By elucidating these factors and seeking solutions, the promotion of the "harmonization of work with treatment and prevention" will both improve working environments and encourage CRF patients to continue working, leading to better socialization. Thus, the "harmonization of working with treatment and prevention" for CRF patients is a core goal for the promotion of both "health and productivity management" and "comprehensive pulmonary rehabilitation". [ABSTRACT FROM AUTHOR]

A questionnaire composed of 35 questions has been prepared (SurveyMonkey™ platform) and sent to all AIPO regional presidents to highlight the institutional, normative and clinical aspects concerning Long-Term Oxygen Therapy (LTOT) applied in the various italian regions and to verify if the Evidence Based Medicine (EBM) criteria are respected. In 15 regions (79%) there is a regional institutional document. In 11 regions (58%) there is a regular computerization of the dates. In 9 regions (47%) a register of patients in LTOT is active. In 18 regions (95%) the prescribers are defined by normative: however only in 13 regions the prescribers are only pneumologists. In some regions (31.5%) LTOT can also be prescribed by anesthesiologists, internists, geriatricians or pediatricians. In 16 regions (84%) there are no restrictive regulatory criteria for current smokers. In 17 regions (89%) an informed consent isn't required. The most used fixed oxygen source for LTOT is the liquid oxygen (77%), while the concentrator is used in 23% of cases. The most used portable oxygen source therefore continues to be the liquid oxygen stroller. The prescriptive criteria of the LTOT for continuous hypoxemia (PaO2 ≤ 55 mmHg) always derives from the basal arterial blood gas analysis; only in 15 out of 19 regions, however, titration is performed. In almost all regions, it is possible to prescribe LTOT for latent hypoxemia (ambulatory and/or nocturnal): they are 18% of total LTOT prescriptions. The prescription of LTOT for borderline hypoxemia (PaO2 between 56 and 60 mmHg) is contemplated in all the regions. [ABSTRACT FROM AUTHOR]

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Background: The aetiologies of chronic respiratory failure (CRF) are moving in many western countries. Obesity-Hypoventilation syndrome (OHS) has become one of the most common indications of non-invasive ventilation (NIV) with Chronic Obstructive Pulmonary Diseases (COPD). Long-Term Oxygen Therapy (LTOT) technology is the treatment plan for CRF patients in the new era. Objectives: This study aimed to assess home-based care evolution in CRF patients on LTOT (LTOT) and/or NIV from the ANTADIR observatory. Methods: A computerized database from 14 regional facilities was analysed (30% of French home-treated patients). Patient age, sex, aetiology, home respiratory devices were recorded between 2001 and 2015. Results: By the end of 2015, 12,147 CRF patients received LTOT (40%), NIV (24%), LTOT + NIV (23%), continuous positive airway pressure (CPAP; 11%) or LTOT + CPAP (3%). Between 2001 and 2015, we observed a decrease of LTOT (63–40%) in the benefit of NVI ± LTOT (25–47%). Regarding the aetiology, we note a slight decrease in obstructive disease and a significant increase in restrictive disease, mainly due to OHS. The 10-year survival was better on NIV ± LTOT than on LTOT, for overall patients and for both obstructive and restrictive patients. The 10-year survival was better on NIV ± LTOT than on LTOT (35 vs. 10%, p < 0.05). In COPD patients on LTOT, a switch from conventional to new home devices was observed. Stationary LTOT systems were less prescribed, while portable/transportable -system, liquid oxygen and self-filling oxygen were increasingly prescribed. Conclusion: Our study confirmed changes in CRF aetiologies and home devices. OHS is now an important indication of NIV. Using new LTOT technologies changed home prescriptions in COPD patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Until recently, it has been considered essential to maintain the use of a doublelimb circuit in patients with amyotrophic lateral sclerosis (ALS) to avoid rebreathing expired air during invasive mechanical ventilation. Currently, life-sustaining home ventilators can work with a single, lighter circuit that is easier to manage. Our aim was to evaluate the effectiveness and safety of a single-limb circuit with intentional leaks (passive circuit) in comparison with a circuit with an expiratory valve (active circuit), in subjects with ALS who use invasive home ventilation. METHODS: We conducted a retrospective single-center study. The enrolled subjects were divided into 2 groups according to the type of exhalation port. The aim of the study was to compare arterial blood gases; nocturnal oxygen saturation recordings; and the occurrence of adverse events, both clinical and technical events. In addition, we compared the rate of mortality and unplanned hospital admissions that occurred within a year after discharge from the hospital. RESULTS: Forty-three subjects were included in our study: 23 who used a passive circuit and 20 who used an active circuit. No significant difference in nocturnal and diurnal gas exchanges was detected. The incidence of adverse events was significantly higher in the active circuit group (85% in active circuit vs 30% in passive circuit, P < .001). However, by splitting the adverse events into 2 categories, clinical and technical, the technical events were significantly more frequent in the active circuit group. None of these events led to hospital admission or death. CONCLUSIONS: The passive circuit was shown to be as effective and safe as the active circuit during home invasive ventilation in the subjects with amyotrophic lateral sclerosis. A future randomized controlled study is necessary to confirm these results and to extend indications to other pathologies. [ABSTRACT FROM AUTHOR]

Today, invasive and non-invasive home mechanical ventilation have become a well-established treatment option. Consequently, in 2010, the German Respiratory Society (DGP) has leadingly published the guidelines on “Non-Invasive and Invasive Mechanical Ventilation for Treatment of Chronic Respiratory Failure.” However, continuing technical evolutions, new scientific insights, and health care developments require an extensive revision of the guidelines. For this reason, the updated guidelines are now published. Thereby, the existing chapters, namely technical issues, organizational structures in Germany, qualification criteria, disease-specific recommendations including special features in pediatrics as well as ethical aspects and palliative care, have been updated according to the current literature and the health care developments in Germany. New chapters added to the guidelines include the topics of home mechanical ventilation in paraplegic patients and in those with failure of prolonged weaning. In the current guidelines, different societies as well as professional and expert associations have been involved when compared to the 2010 guidelines. Importantly, disease-specific aspects are now covered by the German Interdisciplinary Society of Home Mechanical Ventilation (DIGAB). In addition, societies and associations directly involved in the care of patients receiving home mechanical ventilation have been included in the current process. Importantly, associations responsible for decisions on costs in the health care system and patient organizations have now been involved. [ABSTRACT FROM AUTHOR]

Today, invasive and non-invasive home mechanical ventilation have become a well-established treatment option. Consequently, in 2010, the German Respiratory Society (Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, DGP) has leadingly published the Guidelines on “Non-Invasive and Invasive Mechanical Ventilation for Treatment of Chronic Respiratory Failure.” However, continuing technical evolutions, new scientific insights, and health care developments require an extensive revision of the Guidelines. For this reason, the updated Guidelines are now published. Thereby, the existing chapters, namely technical issues, organizational structures in Germany, qualification criteria, disease-specific recommendations including special features in pediatrics as well as ethical aspects and palliative care, have been updated according to the current literature and the health care developments in Germany. New chapters added to the Guidelines include the topics of home mechanical ventilation in paraplegic patients and in those with failure of prolonged weaning. In the current Guidelines, different societies as well as professional and expert associations have been involved when compared to the 2010 Guidelines. Importantly, disease-specific aspects are now covered by the German Interdisciplinary Society of Home Mechanical Ventilation (DIGAB). In addition, societies and associations directly involved in the care of patients receiving home mechanical ventilation have been included in the current process. Importantly, associations responsible for decisions on costs in the health care system and patient organizations have now been involved. [ABSTRACT FROM AUTHOR]

Mechanical Non-Invasive Ventilation (NIV) is a technique widely used in the treatment of acute respiratory failure of Chronic Obstructive Pulmonary Disease (COPD) patients, with benefits largely documented in protocols and guidelines. However, the usefulness of NIV in patients with COPD and chronic respiratory failure is poorly documented. Currently, with the exception of the German guidelines (German Society of Pneumology), no protocols have been defined for the application of NIV in subjects with chronic respiratory failure and COPD. The purpose of this survey is to collect data about the criteria used for the domiciliary prescription of NIV, in the clinical practice of the Pneumology Units of Triveneto. A questionnaire of 10 multiple choice questions was sent by email to all Pneumology Unit of Triveneto. In the 24 centers that answered to the survey, the presence of COPD with persistent hypercapnia (PaCO2 > 60 mmHg) appears to be the main criterion for the domiciliary prescription of NIV. However, some differences emerged, especially regard the patient management. [ABSTRACT FROM AUTHOR]

Background: In this study, we conducted a questionnaire survey to clarify and improve problems related to oxygen concentrators. Methods: Using a questionnaire survey of 30 patients receiving long-term oxygen therapy for chronic respiratory failure, we investigated the necessity of using a remote controller, portability, fire prevention system, built-in battery type and so on. Patients were divided into two groups according to age, sex, underlying conditions and amount of oxygen prescribed, then analyzed accordingly. Results: Mean age was 72.3±8.09 years. The mean flow rate for prescribed oxygen was 1.10 L/min at rest and 2.96 L/min under exertion. Median duration of use was 17.5 months. Built-in battery type, environmentally friendly system and voice guidance system received the most attention according to four-grade evaluations of each function. Significant differences were seen in design features in patients less than 72 years old (P=.03), in voice guidance system in patients who only used the equipment during exertion (P=.01), and in brand imaging in those using the equipment under exertion at a flow ≥3 L/min (P=.04). In questionnaire results for the three most desired features, built-in battery type was of primary concern, followed by portability and use of a remote control. Conclusions: Overall, built-in battery type, portability, use of a remote control and an environmentally friendly system were desired features for oxygen concentrators. Desired features could vary according to age and the amount of oxygen prescribed. [ABSTRACT FROM AUTHOR]

Caring for patients with neuromuscular disease (NMD) is challenging. Respiratory care is of the utmost importance because it is a major determinant of quality of life and survival. Noninvasive ventilation (NIV) is one of the few modalities that has shown survival benefit in the NMD patient population. Newer modes with smart technologies are being developed to assist in better ventilation. Some noninvasive methods have shown success in the management of sialorrhea, which is of paramount importance in the initiation of NIV. This review will summarize the management of respiratory symptomatology in patients with NMD with recent advances made in NIV. [ABSTRACT FROM AUTHOR]

BACKGROUND: The population of children requiring home mechanical ventilation has evolved over the years and has grown to include a variety of diagnoses and needs that have led to changes in the care of this unique population. The purpose of this study was to provide a descriptive analysis of pediatric patients requiring home mechanical ventilation after hospitalization and how the evolution of this technology has impacted their care. METHODS: A retrospective, observational, longitudinal analysis of 164 children enrolled in a university-affiliated home mechanical ventilation program over 26 years was performed. Data included each child's primary diagnosis, date of tracheostomy placement, duration of mechanical ventilation during hospitalization that consisted of home mechanical ventilator initiation, total length of pediatric ICU stay, ventilator settings at time of discharge from pediatric ICU, and disposition (home, facility, or died). Univariate, bivariate, and regression analysis was used as appropriate. RESULTS: The most common diagnosis requiring the use of home mechanical ventilation was neuromuscular disease (53%), followed by chronic pulmonary disease (29%). The median length of stay in the pediatric ICU decreased significantly after the implementation of a ventilator ward (70 d [30-142] vs 36 d [18-67], P = .02). The distribution of subjects upon discharge was home (71%), skilled nursing facility (24%), and died (4%), with an increase in the proportion of subjects discharged on PEEP and those going to nursing facilities over time (P = 0.02). CONCLUSIONS: The evolution of home mechanical ventilation has allowed earlier transition out of the pediatric ICU and with increasing disposition to skilled nursing facilities over time. There has also been a change in ventilator management, including increased use of PEEP upon discharge, possibly driven by changes in ventilators and in-patient practice patterns. [ABSTRACT FROM AUTHOR]

BACKGROUND: Increasing numbers of individuals are being initiated on home mechanical ventilation, including noninvasive (bi-level) and invasive mechanical ventilation delivered via tracheostomy due to chronic respiratory failure to enable symptom management and promote quality of life. Given the high care needs of these individuals, a better understanding of the indications for home mechanical ventilation, and health-care utilization is needed. METHODS: We performed a retrospective cohort study using provincial health administrative data from Ontario, Canada (population ~13,000,000). Home mechanical ventilation users were characterized using health administrative data to determine the indications for home mechanical ventilation, the need for acute care at the time of ventilation approval, and their health service use and mortality rates following approval. RESULTS: The annual incidence of home mechanical ventilation approval rose from 1.8/100,000 in 2000 to 5.0/100,000 in 2012, or an annual increase of approximately 0.3/100,000 persons/y. The leading indications were neuromuscular disease, thoracic restriction, and COPD. The indication for the remainder could not be determined due to limitations of the administrative databases. Of the 4,670 individuals, 23.0% commenced home mechanical ventilation following an acute care hospitalization. Among individuals who survived at least 1 y, fewer required hospitalization in the year that followed home mechanical ventilation approval (29.9% vs 39.8%) as compared with the year prior. CONCLUSIONS: Utilization of home mechanical ventilation is increasing in Ontario, Canada, and further study is needed to clarify the factors contributing to this and to further optimize utilization of health-care resources. [ABSTRACT FROM AUTHOR]

BACKGROUND: The incidence of chronically ill subjects with prolonged mechanical ventilation (PMV) has significantly increased over the last decade because of improvements in acute critical care. The aim of this study was to describe the outcomes and care pathways of subjects receiving PMV through a tracheostomy tube in an intermediate-care facility. METHODS: Sixty-six subjects with chronic respiratory failure who experienced 109 hospitalizations between December 2010 and December 2012 in a 34-bed post-care unit were retrospectively included and followed for at least 1 y. RESULTS: The median (interquartile range [IQR]) length of stay (LOS) was 42 (26-77) d. Subjects were admitted from home (40.4%), our hospital ICU (40.4%; median [IQR] LOS = 17 [7-38] d), or another hospital (19.2%; median [IQR] LOS = 60 [8-71] d, P = .001 vs LOS in ICU). Thirty-five percent of subjects were readmitted at least once during the follow-up period. Sixteen subjects died in the intermediate-care facility. Discharge destinations of alive subjects were home (n = 78), another hospital (n = 6), a skilled-nursing facility (n = 5), or an ICU (n = 4). A complete or partial weaning was obtained in 30.3% of subjects. One year after the first day of hospitalization, 57% of subjects were alive. CONCLUSIONS: Despite the chance of survival at 1 y and/or weaning from ventilation, the resources needed by subjects with PMV are high, as shown by the number of readmissions and long LOS in our unit and in other hospital units before transfer. [ABSTRACT FROM AUTHOR]

Few studies have analyzed the prevalence and accessibility of home mechanical ventilation (HMV) in Italy. We aimed to investigate the prevalence and prescription variability of HMV as well as of long-term oxygen therapy (LTOT) and continuous positive airway pressure (CPAP), in the Lombardy Region. Prescribing rates of HMV (both noninvasive and tracheostomies), CPAP (auto-CPAP, CPAP/other sleep machines) and LTOT (liquid-O2, O2-gas, concentrators) in the 15 Local Healthcare districts of Lombardy were gathered from billing data for 2012 and compared. Crude rates (per 100,000 population) and rates for the different healthcare districts were calculated. In 2012, 6325 patients were on HMV (crude prescription rate: 63/100,000) with a high variation across districts (8/100,000 in Milano 1 vs 150/100,000 in Pavia). There were 14,237 patients on CPAP (crude prescription rate: 142/100,000; CPAP/other sleep machines 95.3% vs auto-CPAP 4.7%) with also high intra-regional variation (56/100,000 in Mantova vs. 260/100,000 in Pavia). There were 21,826 patients on LTOT (prescription rate: 217/100,000 rate; liquid-O2 94%, O2-gas 2.08%, O2-concentrators 3.8%), with again high intra-regional variation (100/100,000 in Bergamo vs 410/100,000 in Valle Camonica). The crude rate of HMV prescriptions in Lombardy is very high, with a high intra-regional variability in prescribing HMV, LTOT and CPAP which is partly explainable by the accessibility to specialist centers with HMV/sleep-study facilities. Analysis of administrative data and variability mapping can help identify areas of reduced access for an improved standardization of services. An audit among Health Payer and prescribers to interpret the described huge variability could be welcomed.