Patient outcomes

The benefits of using NIV at home for Type 2 COPD patients include:

  • Improved daytime and nocturnal PaCO2 during oxygen breathing
  • Reduced risk of any clinical deterioration
  • Significant improvement in quality of life, both in physical and mental capacity1-2
  • Positive effects on gas exchange2
  • Improved exercise tolerance, mood state, dyspnoea scores, and FEV1 in severe COPD patients with chronic hypercapnic respiratory failure2
  • Reduced cost of health care, with lower hospitalization rates, shorter hospital stays and less time between re-admissions3

Further large randomized, controlled trials are underway to confirm the above benefits.4

Special considerations

COPD patients have a high work of breathing (WOB) and experience difficulty exhaling air from their lungs.

  • Pressure support (PS) assists a patient’s breathing to allow more volume to enter their lungs, decreasing their WOB.
  • Higher pressures may be needed to reduce or normalize PCO2 levels in COPD patients.5
  • Appropriate PS decreases the patient’s WOB, which lowers their respiratory rate and allows more time to exhale.

Less time spent in inspiration allows more time in expiration, allowing intrinsic PEEP to decrease further, leading to a decrease in WOB.

  • ResMed's TiControl™ feature allows clinicians to set a maximum value for time spent in inspiration, which ensures effective cycling to prolong the time spent in expiration.
  • ResMed’s unique synchrony allows fast rise times and prompt responses to patient effort.

It is essential to maintain reliable breath triggering and cycling synchronisation between the patient and the device.

  • On all ResMed devices, the Vsync leak management algorithm works in sync with the TiControl feature. Vsync monitors and compensates for leak by continuously and automatically adjusting the baseline flow, while TiControl assures a minimum and maximum inspiratory time.
  • Trigger and cycle adjustment can also help with synchronisation.

COPD patients usually require supplemental oxygen with NIV.

  • ClimateLineMAX Oxy allows oxygen to be added at the back of the device for more accurate delivery; up to 15L/min can be added. If using the Stellar device, no ClimateLineMAX Oxy is required and up to 30L/min can be added to the patient's therapy.

  • SpO2 can be monitored to help titrate oxygen.
  • FiO2 can be measured and monitored directly on the Stellar LCD screen when required.

The key to treating patients with COPD is patient acceptance and adherence to the therapy (especially at night time).

  • ResMed products facilitate a fine adjustment of trigger and cycle sensitivities, as well as rise time settings to optimise comfort and ease of breathing.
  • Comprehensive patient monitoring options also assist in promoting the patient’s adherence to therapy.

COPD patients may also have overlap syndrome: COPD with obstructive sleep apnoea (OSA).

  • If overlap syndrome is diagnosed, EPAP is also titrated to overcome the upper airway collapse due to OSA.
  • AHI data viewed on the Stellar and VPAP COPD info screen or via ResScan™ will help you identify the need for EPAP adjustment.
  • High-resolution flow data can help titrate EPAP and identify PEEPi.

Integrated humidification can be used to support the patient's breathing.

During all stages of COPD, it is vital to monitor the patient and their progress.

  • ResMed's advanced data management solutions give care providers access to detailed data for troubleshooting and monitoring patient progress as required.

You get device and card data storage with high-resolution flow and pressure data, usage hours, volumes, percentage of spontaneous breaths, respiratory rate, AHI, SpO2 and synchronisation details, and access to ResScan software.

ResMed's Stellar Series ventilators can also display live data (such as flow and pressure curves) as well as summary data on the device itself.

  • Real-time therapy monitoring allows ideal patient titration, optimal follow-up, and adjustment of therapy settings as the disease progresses.6
  • ResMed’s VPAP COPD, Stellar 100 and 150 ventilators allow comprehensive real-time monitoring.

Quality of life considerations are also important for those with on-going chronic conditions.1-2

  • Whether the patient’s device is powered by an internal battery or ResMed's external battery — the ResMed Power Station II (RPSII) — an independent power sources helps patients maintain their independence, encourages rehabilitation compliance and enhances quality of life.

References

  • 01

    Tsolaki V, Pastaka C, Karetsi E et al. One-year non-invasive ventilation in chronic hypercapnic COPD: Effect on quality of life. Respir Med 2008; 102:904–911

  • 02

    Duiverman ML, Wempe JB, Bladder G, Jansen DF, et al. Nocturnal noninvasive ventilation in addition to rehabilitation in hypercapnic patients with COPD. Thorax 2008; 63:1052–7

  • 03

    Tuggy JM, Plant PK, Elliott MW. Domiciliary noninvasive ventilation for recurrent acidotic exacerbations of COPD: An economic analysis. Thorax 2003; 58:867–871

  • 04

    The Study of the Efficacy of Home Mechanical Ventilation Post Acute Hypercapnic Exacerbation of Chronic Obstructive Pulmonary Disease (COPD), Guy’s & St Thomas’ Charity, UK. Collaborators: ResMed and ResMed Foundation. Sponsor: Patrick Murphy.

  • 05

    Schonhofer B. Noninvasive positive pressure ventilation in patients with stable hypercapnic COPD: Light at the end of the tunnel? Thorax 2010; 65:765–767

  • 06

    Jean-Paul Janssens et al on behalf of the SomnoNIV Group. Nocturnal monitoring of home noninvasive ventilation: The contribution of simple tools such as pulse oximetry, capnography, built-in ventilator software and autonomic markers of sleep fragmentation. Thorax 2011; 66:438–445

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