CHEST Guidelines-Long-Term-Noninvasive-Ventilation-in-the-Geneva-La

Long-Term-Noninvasive-Ventilation-in-the-Geneva-La

Pdf Summary

This observational study examines the evolution of noninvasive ventilation (NIV) usage over 15 years in the Geneva Lake area, focusing on patient demographics, indications, device modalities, and long-term efficacy. By including all individuals on NIV in Geneva and Vaud with a total population of 1.3 million, 489 patients were analyzed. The prevalence of chronic hypercapnic respiratory failure, treated by NIV, rose 2.5 times since 2000 to 38 per 100,000 inhabitants. The majority of participants (median age of 71 years) were older, with a significant proportion being at least 75 years old and obese, displaying a median three comorbidities per person. Chronic Obstructive Pulmonary Disease (COPD) represented the largest portion of patients (39%), followed by those with obesity hypoventilation syndrome (OHS, 26%). Most patients achieved normalized daytime PaCO2 levels and exhibited good adherence to NIV.<br /><br />NIV was primarily started in a hospital setting (82%), with 86% using bilevel positive pressure ventilators in a spontaneous/timed mode. This primarily included fixed settings for expiratory and inspiratory pressures with minimal usage of autotitrating ventilators. The use of multimodal ventilators decreased notably in favor of more user-friendly ventilators that utilize built-in software for monitoring treatment efficacy. Major diagnostic criteria included the presence of severe COPD, overlap syndrome, OHS, and neuromuscular diseases.<br /><br />The study highlights a significant trend in the increasing acceptance and application of NIV, demonstrating its effectiveness in maintaining respiratory function in an aging and increasingly comorbid population. Importantly, it emphasizes the need for updated, tailored respiratory care practices, as the characteristics of NIV users have shifted from initial restrictive disease conditions to predominantly COPD and OHS as main indications.

Keywords

noninvasive ventilation

chronic hypercapnic respiratory failure

Chronic Obstructive Pulmonary Disease

obesity hypoventilation syndrome

patient demographics

bilevel positive pressure ventilators

respiratory care practices

Geneva Lake area

long-term efficacy

comorbidities