The role of new noninvasive ventilation modes in home care and hospital settings

Simon Oczkowski, MD, MHSc, MSc, is an associate professor of medicine in the Division of Critical Care at McMaster University.

New noninvasive ventilation (NIV) devices offer many modern ventilation modes. Do you think that they provide an advantage in the treatment of “typical” chronic obstructive pulmonary disease (COPD) hypercapnic respiratory failure?

NIV machines now can do many different modes. The typical mode that we use is either a pressure support mode, where the patient triggers a breath and the machine provides a supported breath, or an assist control mode, where the machine has a set rate.

The new modes that we’re seeing now are often what we call adaptive modes, where the computer inside the machine... you can set a tidal volume or minute ventilation and the computer adapts to the patient’s requirements. This has some nice benefits if you’re thinking about patients who perhaps have changing sleep patterns and are wearing this overnight, or perhaps their disease may progress and they need new settings. And it stops you from having to bring them to a laboratory to readjust the machine settings.

The evidence for these devices is still emerging, and typically in the acute care setting, like a hospital or emergency department, I don’t see a role for them. Those patients are too acute and too sick and really need lots of hand-on control of the settings.

But for patients in the home care setting who are wearing these devices at home, I think it’s… you have to balance out the benefits of quick and easy adjustment done by the machine versus the fact that there is no one monitoring those changes. And so, how safe and how effective is it versus the challenges of bringing a patient into a sleep laboratory to readjust. Those decisions should be made on a case-by-case basis.