SESSION TITLE: Pulmonary Rehabilitation
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 26, 2015 at 07:30 AM - 08:30 AM
PURPOSE: Ambulatory patients with severe chronic respiratory insufficiency (CRI) may benefit from mechanical ventilator support that is applied through a non-invasive interface and is portable. The Non-invasive Open Ventilation (NIOV™) System, a portable FDA cleared mechanical ventilator with nasal interface, has previously been shown to improve exercise endurance and arterial oxygenation, reduce dyspnea and respiratory muscle load, and to increase the ability to perform activities of daily living in patients with chronic respiratory disease. For this study, we compared health care utilization and respiratory symptoms in patients before and after NIOV implementation.
METHODS: Sixteen stable oxygen dependent CRI patients who had the NIOV system added to their standard treatment regimen were chosen because of the availability of complete medical records for at least 3 months after initiation of NIOV. After obtaining informed consent, a retrospective chart review was undertaken for up to 1 year pre and 1 year post NIOV initiation. Information included diagnosis, demographics, respiratory function, physician visits, emergency department (ED) visits, hospital and ICU admissions, inpatient and ICU days, mechanical ventilation days, and two validated patient reported measures of respiratory symptoms (CAT and mMRC). Paired t-tests and Wilcoxon matched pairs signed rank tests were used as appropriate to compare pre and post values with p<0.05 taken as significant.
RESULTS: Mean ± SD pre-NIOV and post-NIOV time periods were 11.2 ± 4.7 months and 11.6 ± 5.0 months, respectively. (p=0.7905). Mean health care utilization data pre and post NIOV initiation are shown below: Physician office visits: 5.4 vs 5.9 p=NS ED visits: 1.9 vs. 0.6, p=0.0099 Inpatient admissions: 1.6 vs. 0.4, p=0.0012 Inpatient Days: 7.6 vs. 1.3, p=0.0009 ICU Days: 2.6 vs. 0.3, p=0.0156 Mechanical ventilation days: 2.6 vs. 0.1 p=NS COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) scores improved significantly in the post-NIOV implementation period (p < 0.0001 and p=0.0001, respectively).
CONCLUSIONS: In this cohort of ambulatory CRI patients, the introduction of a portable non-invasive mechanical ventilator system to the treatment regimen was associated with reduced health care utilization and improved symptoms.
CLINICAL IMPLICATIONS: The results suggest that the use of a portable non-invasive ventilator may translate into more cost effective care in patients with CRI.
DISCLOSURE: Robert Morsighe: Consultant fee, speaker bureau, advisory committee, etc.: Breathe Technologies Kevin Farberow: Consultant fee, speaker bureau, advisory committee, etc.: Breathe Technologies Neil MacIntyre: Consultant fee, speaker bureau, advisory committee, etc.: Breathe Technologies
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