Telemedicine and Ventilator Titration in Chronic Respiratory Patients Initiating Non-invasive Ventilation
Telemedicine and Ventilator Titration in Chronic Respiratory Patients Initiating Non-invasive Ventilation
The critical nature of respiratory diseases, the continuously increasing prevalence of these
 conditions, and the subjective perception of patients vis-à-vis their pulmonary function and
 health status underscore the importance of home telemonitoring. These conditions are critical
 and necessitate close and regular monitoring that may be achieved at distance using
 telemonitoring. This study will assess a number of measures both at baseline and
 post-intervention from a number of domains, including Arterial Blood Gases (ABG),
 BiPAP-related data, chronic respiratory failure symptoms, health-related quality of life,
 patients satisfaction and utilization of healthcare resources.
In recent years home care is becoming increasingly used and considered by some the future of
 healthcare. Home mechanical ventilation has been shown to improve morbidity and mortality in
 patients with chronic respiratory failure of different aetiologies. A French survey suggests
 an increase of 12% of cases per year. With the prospect of a substantial increase of
 ventilated patients at home, facilities and resources have not been proportionally growing,
 so new approaches should be investigated and addressed to absorb this constant flux of
 patients.

 Telemedicine is defined as the broad use of electronic and communications technologies to
 provide and support remote monitoring of health status. It has been shown to be an effective
 alternative model of care for managing chronic diseases. It as also been shown to reduce
 healthcare costs and is a major topic on the agendas of health and social care policies in
 Europe.

 Home telemonitoring of respiratory conditions results in early identification of
 deteriorations in patient condition and symptom control.

 However, evidence on the magnitude of clinical and structural effects remains preliminary,
 with variations in study approaches and an absence of robust study designs and formal
 evaluations.

 The objective is gathering data that can be help to establish guidelines for non invasive
 home mechanical ventilation initiation and quality control.
Inclusion Criteria:

 OHS:

 -  PaCO2 > 45 mmHg;

 -  IMC > 40 Kg/m2

 COPD:

 -  Age < 80 years;

 -  Receiving appropriate medical therapy according to gold guidelines

 -  Long-term oxygen therapy (LTOT) for at least 3 months;

 -  PaCO2 > 50 mmHg during room air

 -  ph > 7,35 and free from exacerbations in the 4 weeks preceding recruitment;

 -  One exacerbation in the last year before preceding recruitment with necessity of NIV
 in the acute care setting;

 -  FEV1 < 1,5l or < 50% predicted;

 -  FEV1/FVC < 60%

 -  Total Lung Capacity (TLC)≥ 90% predicted;

 -  PaO2 < 60 mmHg breathing room air at rest.

 NMD and CWD:

 -  PaCO2 > 45 mmHg;

 -  Significant nocturnal desaturation

 -  FVC < 50% predicted;

 -  SNIP < 40 cmH20

 -  MIP < 60% predicted

 -  Ortopnea;

 -  20% drop of VC in supine position.

 Exclusion Criteria:

 OHS:

 -  COPD

 -  NMD

 COPD:

 -  15% increase in FEV1 after inhaled Salbutamol (200 µg);

 -  Active smoking;

 -  History of OSA (with AHI > 15 episodes.h-1)

 NMD and CWD:

 -  COPD;

 -  OHS;

 -  PCF < 270;

 -  Severe bulbar weakness (ALSFRS bulbar subscore 0-3)

 -  MIC/VC=1