S58 The use of remote monitoring to assess ventilator adherence and outcomes within a regional home mechanical ventilation service. (15th November 2016) - Gn, YM
Abstract : Introduction: Home mechanical ventilation (HMV) is a recognised evidence-based intervention for patients in chronic respiratory failure (CRF). However there is a paucity of evidence on the adherence to this treatment. This study examined the adherence of HMV and evaluated the clinical outcomes associated with adherence in a variety of patient populations – namely neuromuscular disease, chest wall disease, obesity hypoventilation syndrome and chronic obstructive pulmonary disease (COPD). Methods: A retrospective study was carried out between May to June 2016. Adherence data was downloaded through remote monitoring. Primary outcomes included changes in blood gases at 3 and 6 months, and hospital admissions 12 months pre- and post-ventilation. Qualitative outcomes were obtained through a questionnaire conducted via telephone interviews. Results: 62 patients were included in this study. Patients undertaking remote monitoring of HMV demonstrated an adherence rate of 90.3%, defined as more than 4 hours of ventilator use/night (mean [SD] = 7h 17min [2h 53min]). No significant difference in adherence was found between patients of different aetiologies. The blood gases improved significantly at 3 months compared to baseline (p < 0.05). However, there was a universal trend for these parameters to return to baseline at 6 months regardless of the underlying disease. HMV reduced hospital admissions by 1.07 (1.27) per individual per annum (p < 0.0001) and was most significant in the COPD group (p = 0.005). All patient groups indicated that HMV improved their quality of life. Conclusion: This study has demonstrated that contrary to existing evidence, the adherence to HMV was extremely good across all diseases. Remote monitoring may play a role in this increased adherence. Although HMV contributed to improvements in blood gases at 3 months, there was a universal trend for these parameters to return to baseline at 6 months in all disease states despite good adherence. Our data therefore suggests that early follow-up is essential to detect deterioration and support the need for palliation. Nevertheless HMV remains an effective treatment to reduce hospital admissions and improve quality of life, if patients are adherent to the intervention.