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1. Effect of telemonitoring on the rate of dropout during home non-invasive ventilation: a retrospective study using a home care provider database

Author

Wojciech Trzepizur, Frédéric Gagnadoux, Raphael Le Mao, Christophe Gut Gobert, Joelle B Texereau, Frédérique Kremer, Marion Goret, Aurélie Chekroun Martinot, and Mathieu Rosé

Subjects
Medicine
Abstract

Objectives Telemonitoring (TM) of home non-invasive ventilation (NIV) has been shown to facilitate home/outpatient therapy set-up. However, the impact of long-term TM on therapy dropouts, compliance and leak control has not yet been clearly determined. This study evaluated whether the NIV dropout rate was reduced by TM combined with remote patient support compared with a non-telemonitoring (NTM) pathway.Design Retrospective cohort study.Setting Data were obtained from all agencies of a single home care provider in France.Participants Adults with chronic respiratory failure (n=659) who started nocturnal NIV between January 2017 and December 2019 and had ≥8 days of NIV therapy (51% male; mean age 68.5±13.8 years; 35.5% on long-term oxygen therapy) were included. The TM group included 275 patients who spent ≥80% of the follow-up using TM, and the NTM group included 384 patients who had 0 to ≤10 days of telemonitoring during follow-up.Primary and secondary outcome measures The primary outcome was the rate of NIV dropouts at 1 year (ie, treatment discontinuation, excluding deaths). Secondary outcomes included therapy compliance and leaks.Results 82 patients died during follow-up. Significantly fewer patients in the TM vs NTM group had dropped out of NIV therapy at 1 year (13% vs 34%; p4 hours/day and control of leaks.Conclusions In patients starting home NIV, TM with home care provider first-line support was associated with a lower therapy dropout rate at 1 year, and better compliance and leak control, compared with standard follow-up.

Published
2024
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2. Effect of Local Anesthesia on Pain During Arterial Puncture: The GAEL Randomized Placebo-Controlled Trial

Author

Marc Beaumont, C. Tromeur, Alexandre Fauche, Christophe Leroyer, Veronique Darnois, Emmanel Nowak, Charles Orione, Francis Couturaud, Marion Goret, Virginie Cogulet, Angelina Dion, and Raphael Le Mao

Subjects
Pulmonary and Respiratory Medicine, Lidocaine, Placebo-controlled study, Pain, Punctures, Critical Care and Intensive Care Medicine, Placebo, Prilocaine, law.invention, 03 medical and health sciences, symbols.namesake, 0302 clinical medicine, Double-Blind Method, Randomized controlled trial, law, medicine, Humans, Local anesthesia, Lidocaine, Prilocaine Drug Combination, Pain Measurement, business.industry, General Medicine, Bonferroni correction, 030228 respiratory system, Anesthesia, Relative risk, symbols, business, Anesthesia, Local, medicine.drug
Abstract

BACKGROUND: Arterial puncture is often painful for patients. The aim of this study was to compare use of local anesthesia as a eutectic mixture of 2 local anesthetics, lidocaine and prilocaine, versus placebo. METHODS: We conducted a double-blind, randomized controlled trial. Subjects were eligible if arterial puncture was indicated. The primary outcome was an experienced pain > 2 on a numerical pain rating scale. As having had a previous experience of arterial puncture was expected to be predictive of the current response, we planned 3 comparisons between use of local anesthesia and placebo: in the whole sample, among subjects with a painful previous experience, and among subjects with a painless previous experience. Multiple testing was analyzed using the Bonferroni correction for the primary outcome. The secondary outcome was the numerical pain rating scale score itself. All analyses were performed on an intention-to-treat basis. RESULTS: A total of 136 subjects were included in this study. The primary outcome occurred in 20.9% in the active arm versus 37.7% in the placebo arm in the whole sample (relative risk 0.55; 95% CI when adjusting for multiple testing ranged was 0.28–1.09, P = .10; 95% CI without adjustment was 0.32–0.97, P = .038). No significant heterogeneity in the study treatment effect was found when considering previous painful or painless arterial puncture (P = .70). The numerical pain rating scale score was 1.55 ± 2.03 in active group versus 2.09 ± 2.15 in the placebo group (P = .13). CONCLUSIONS: We found that application of a eutectic mixture reduced the number of painful arterial punctures by 50% compared with placebo. However, this result was not statistically significant. (ClinicalTrials.gov registration NCT01964248.)

Published
2021

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