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Monitoring home mechanical ventilation: Polysomnography or built-in ventilator software?
Jean-Michel Arnal1, Sonia Khirani2
1Service de Réanimation Polyvalente et Unité de Ventilation à Domicile, Hôpital Sainte Musse, Toulon, France.
Abstract:
Monitoring of home mechanical ventilation (HMV) and continuous positive airway pressure (CPAP) is essential to guarantee an efficient ventilation. Hospital attended polysomnography (PSG), or at least respiratory polygraphy, remains the gold standard for the monitoring of HMV/CPAP. However, it is time-consuming, costly and not practical. Built-in ventilator software data represent a good alternative, but some limitations have to be acknowledged. Adherence, leaks and patient-ventilator asynchrony (PVA) are among the main data to monitor, and the analysis of these data can be easily done using built-in ventilator software. Residual respiratory events can also be monitored using built-in ventilator software, with the limitation that their identification and characterization are not always optimal. PSG may be indicated when the analysis of breath-by-breath waveforms of built-in ventilator software is not conclusive. PSG or thoraco-abdominal belts connected to a ventilator may also be useful to identify PVA related to an insufficient pressure support. This review summarizes the information available when using built-in ventilator software data, highlighting their advantages and drawbacks as compared to PSG for the monitoring of HMV/CPAP, and addresses the situations where one approach may be more appropriate than the other. The availability of thoraco-abdominal belts for additional ventilators may represent a valuable development, enabling an improved monitoring of HMV/CPAP, particularly in settings with limited resources.
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