Telemonitoring for Home-assisted Ventilation: A Narrative Review

Abstract

The recent advent of remote ventilator telemonitoring has the potential to revolutionize home-assisted ventilation care in the United States and elsewhere. Home ventilation machines (i.e., respiratory assist devices and portable ventilators) can now wirelessly transmit usage and performance data to cloud-based web servers for remote access by participating clinicians. In this Focused Review, we provide an update on available technology, suggest practical applications for clinical care and research, and review supporting literature. Remote monitoring permits early data review, refinement of device settings to optimize ventilatory function, and troubleshooting if a new problem arises after initial setup. Data from home spirometry and noninvasively measured blood gas tensions can complement ventilator data to reflect physiological response. Acknowledging a paucity of published outcome studies, remote telemonitoring may be a cost-effective strategy to reduce emergency room visits, urgent clinic appointments, and hospitalizations. Ongoing clinical trials in Europe aim to expand on the benefit of this rapidly evolving technology. However, several barriers may hinder widespread implementation, especially in the United States. Clinicians must familiarize themselves with each ventilator manufacturer's proprietary software to safely leverage this technology for improving care. Legal and ethical considerations threaten clinician interest. Medical insurance payers must adapt a reimbursement scheme to incentivize clinicians and durable medical equipment companies to perform this time-consuming service. Cohort-level ventilator data will facilitate multicenter clinical trials focused on improving the respiratory care of this vulnerable population.

Keywords: chronic respiratory failure; home ventilation; noninvasive ventilation; telemedicine; telemonitoring.

Figure 1.

(A) Manual download approach with disconnect between patient and clinician, necessitating durable medical equipment company facilitating ventilator settings. (B) Telemonitoring approach with improved connectivity between patient and clinician, permitting clinician-directed ventilator settings. DME = durable medical equipment.

Figure 2.

Care Orchestrator display of hourly ventilator usage by day.

Figure 3.

Care Orchestrator display of average daily minute ventilation, tidal volume, and airway pressures. Avg = average; EPAP = expiratory positive airway pressure; IPAP = inspiratory positive airway pressure.

Figure 4.

Care Orchestrator overnight recording showing tidal volume varying with leak. Avg = average; Vte = exhaled tidal volume; Vti = inhaled tidal volume.

Figure 5.

Overnight transcutaneous carbon dioxide and pulse oximetry recording for a patient with amyotrophic lateral sclerosis. (A) Overnight transcutaneous carbon dioxide and (B) pulse oximetry recording.

Figure 6.

Patient undergoing titration of noninvasive ventilation with a ResMed Astral in an outpatient clinic while monitoring peripheral capillary oxygen saturation and transcutaneous carbon dioxide simultaneously (image obtained and published with patient permission).

Figure 7.

Multiple areas of vulnerability in a remote telemonitoring system.