Built-in monitoring data in noninvasive home ventilation

Body: The key of noninvasive home ventilation (HMV) setting is the evaluation of the noninvasive ventilation (NIV) adaptation during wake and above all during sleep by built-in monitoring data. Aim: Evaluation of built-in monitoring data for HMV setting. Methods: We analyzed 62 patients (pts): 9 COPD, 17 obesity-hypoventilation syndrome (OHS), 32 neuromuscular disease, 3 kyphoscoliosis. NIV titration was performed in wake (99% of pts by ST mode), followed by serial revaluations after 1 month and 3 or 6 months linked to pathologies (T1;T3-T6), with ABGs and built-in monitoring data implemented by overnight pulse oximetry. Results: Significant PCO2 reduction was observed in all groups already in T1 (from titration to T1 51.9 mmHg vs 47.2 mmHg, p= 0.003;from titration to T3-T6: 51.9 mmHg vs 44.7 mmHg, p=0.007). By the built-in software analysis from T1 to T3-6, we found an increased trend in NIV compliance in all groups, except in OHS (336.21 min vs 294.29 min; p=0.024); the percentage of spontaneous trigger was significantly reduced in neuromuscular pts (70.65% vs 55.91%, p=0.008), while remained unchanged over time in the other groups of pts. Instead, tidal volume, mean respiratory rate and mean inspiratory time was stable. After built-in software analysis, at T1 setting variations were 60: 1 in 37 pts, 2 in 5 pts, 3 in 3 pts and 4 in 1 pts. At T3-6 setting variations were 37: 1 in 15 pts and 2 in 11 pts. Conclusion: NIV improves respiratory exchanges in all patients enrolled. Built-in monitoring data implemented by overnight pulse oximetry is crucial to establish setting HMV variations. A correct back-up respiratory rate setting plays an important role to avoid nocturnal hypoventilation especially in neuromuscular pts.