TYPE: Abstract
TOPIC: Sleep Disorders
PURPOSE: In the absence of LTV, HRF leads to recurrent hospital admissions, poor quality of life and increased mortality. Anticipating a significant surge in SARS-CoV-2 related hospital admissions, staff redeployment and Non-Invasive Ventilation (NIV) being considered as an aerosol generating procedure, we implemented a remote LTV initiation and review service and have evaluated the clinical outcomes.
METHODS: Consecutive patients started on LTV over the last 12 months (April 2020- March 2021) were included. Patient demographics, LTV indications, trial duration, remote review and clinical outcomes were evaluated.
RESULTS: Patients (n=54, mean age; 60+/-16, mean FEV1; 45+/-24, mean BMI; 39+/-18 males-54%) were initiated on LTV trial. The indications for LTV were OHS-56%, COPD-28%, NMD-7.5%, Chest wall disorders-6% and others-2.5%. A third of patients needed supplemental oxygen therapy (2-4 lts/16-24 hours/day). The median (IQR) duration of LTV trial was 4.3 (1-5-4.5) months and mean (SD) NIV compliance was 5.5 (2.3) hours. Patients were regularly monitored remotely (via modem or telephone) and this prevented hospital admissions in 56% of patients. There was a significant improvement in pCO2 was noted (P -0.0009, mean pCO2 pre LTV: 9 +/- 2.85 v/s post LTV: 6.7 +/- 1.3, Δ change 2.2 kpa, 95% CI: 1.2 -3.52). 9.3% had SARS-CoV-2 infection with all-cause mortality of 3.7%.
CONCLUSIONS: LTV can be initiated and monitored remotely but appropriate patient selection and a well organised LTV team is prudent.
CLINICAL IMPLICATIONS: Adequate compliance and improvement of hypercapnia are key parameters of good outcome with LTV and remote monitoring may be cost effective.
DISCLOSURE: Nothing to declare.
KEYWORD: remote Long term ventilation