Compliance with home mechanical ventilation: key factors for a succesfull therapy

compliance Screening tools Home mechanical ventilation

Prof. dr. M.L. Duiverman
G. Bladder
T. Raveling

Nature of the research:
Development of a screening tool to assess compliance with HMV and prospective validation of this tool

Fields of study:
epidemiology and statistics pulmonology intensive care

Background / introduction
Since the polio epidemic in the 1950s, assisting patients with chronic respiratory failure with invasive or noninvasive mechanical ventilation has become increasingly available, also at home. In the Netherlands, the number of patients treated with home mechanical ventilation (HMV) has increased from 200 in 1991 over currently up to 2000 patients, mostly on non-invasive (mask-)ventilation.1 The last decades, patient groups have changed; from initially in 1950s poliomyelitis patients to nowadays an increasing proportion of patients with amyotrofic lateral sclerosis (ALS), patients with lung diseases such as chronic obstructive pulmonary disease (COPD), and patients with obesity hypoventilation syndromes (OHS).
The primary aim of HMV is, in all patients, an improvement in health-related quality of life. While HMV might also lengthen survival enormously, as happens in for example patients with Morbus Duchenne,2 there are also patient groups in whom survival benefit has not been shown that convincingly, but improvement in health-related quality of life has been.3,4 However, for an effective therapy patients need to use their ventilator for a sufficient hours per day, thereby actually improvement their respiratory situation. Unfortunately not all patients succeed in getting used to this rather demanding therapy, i.e. sleeping with a mask while air is blown into your lungs, and once patients got used to it, actual compliance rate vary. As caregivers, we do not know which factors influence success rates and compliance with HMV. Therefore, a proper patient selection before the start of HMV is lacking. The goal of this research is to develop a screening tool for prediction of a successful HMV before the start of this rather demanding therapy.
Research question / problem definition
project is to develop a screening tool for prediction of a successful HMV before the start of this rather demanding therapy and to validate this tool prospectively.
The student will first develop the screening tool using the factors that were retrospectively identified, and will additionally identify factors by interviewing expert caregivers in the field. A screening tool will be developed according to guidelines. Afterwards this screening tool will be tested prospectively in all patients starting on HMV at the HMC center Groningen.
The student will participate in our team of the HMV centre Groningen and will participate in the outpatient clinics and inpatient care of patients starting on HMV. The student will be responsible for the gathering of data needed to fulfill the screening tool in patients starting on HMV. Furthermore, the student will be involved in running research projects, as also data from these projects are used. Furthermore, the student will get the unique opportunity to learn about HMV, a very specialized area of care, more in general and research in this field.
1. Hazenberg A, Cobben NA, Kampelmacher MJ, Rischen J, Wijkstra PJ. Home mechanical ventilation in the netherlands. Ned Tijdschr Geneeskd. 2012;156(3):A3609.
2. Simonds AK, Elliott MW. Outcome of domiciliary nasal intermittent positive pressure ventilation in restrictive and obstructive disorders. Thorax. 1995;50(6):604-609.
3. Duiverman ML, Wempe JB, Bladder G, et al. Nocturnal non-invasive ventilation in addition to rehabilitation in hypercapnic patients with COPD. Thorax. 2008;63(12):1052-1057.
4. Duiverman ML, Wempe JB, Bladder G, et al. Two-year home-based nocturnal noninvasive ventilation added to rehabilitation in chronic obstructive pulmonary disease patients: A randomized controlled trial. Respir Res. 2011;12:112-9921-12-112.
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Laatst gewijzigd: 23 februari 2012