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Practice Guideline
. 2025 Nov 25;66(5):2500094.
doi: 10.1183/13993003.00094-2025. Print 2025 Nov.

European Respiratory Society clinical practice guideline on telemedicine in home mechanical ventilation

Marieke L Duiverman  1   2 , Carla Ribeiro  3   4 , Thomy Tonia  5 , Anda Hazenberg  6   2 , Stien van Meerloo  7 , Hans van Meerloo  7 , Stefanie Werther  8 , Christoph Schöbel  8 , Aylin Özsancak Uğurlu  9 , Jean-Christian Borel  10   11 , Cristina Jácome  4 , Maxime Patout  12   13 , Karen Ward  14 , Clare Williams  15 , Begum Ergan  16 , Christopher Carlin  17 , Patrick Murphy  18   19 , Raffaela Dellacà  20 , Michele Vitacca  21 , Claudia Crimi  22   23
Affiliations
Practice Guideline

European Respiratory Society clinical practice guideline on telemedicine in home mechanical ventilation

Marieke L Duiverman et al. Eur Respir J. .

Abstract

Background: With the increasing prevalence of patients on home mechanical ventilation (HMV), changing indications, shortage of hospital resources and rapidly evolving technology, there is an urgent need for evaluating the added value of telemedicine in initiation and follow-up of HMV. This European Respiratory Society (ERS) clinical practice guideline provides evidence-based recommendations on the use of telemedicine in HMV.

Methods: The ERS Task Force consisted of 20 members, including a patient representative and her caregiver. The Task Force addressed five PICO (Population, Intervention, Comparison, Outcome) questions and three narrative questions. Systematic searches were performed in MEDLINE, Embase, Cochrane and CINAHL. Evidence was synthesised by conducting meta-analyses, when possible, or when not, narratively. Certainty of evidence was rated with GRADE (Grading of Recommendations Assessment, Development and Evaluation) guidance. The Evidence-to-Decision framework was used to decide on the direction and formulate strengths of recommendations.

Results: The panel makes a conditional recommendation for the initiation of HMV with telemedicine in patients with neuromuscular diseases or restrictive thoracic diseases and in patients with COPD. No recommendation could be made for obesity hypoventilation syndrome. The panel conditionally recommends the use of telemedicine for the follow-up of patients on HMV, although could not make recommendations on parameters to be monitored. Suggestions were mainly based on theoretical benefits and patient preferences, as our confidence in the evidence was low.

Conclusions: With these guidelines, clinical practice recommendations are provided for the use of telemedicine in HMV. Technological advances and the use of advanced data processing algorithms and artificial intelligence were identified as drivers for future research and telemedicine use.

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Conflict of interest statement

Conflicts of interest: M.L. Duiverman reports support for the present study from the European Respiratory Society, grants from ResMed, Löwenstein, Vivisol, Sencure and Fisher & Paykel, payment or honoraria for lectures, presentations, manuscript writing or educational events from Chiesi, Breas and AstraZeneca, receipt of equipment, materials, drugs, medical writing, gifts or other services from ResMed, Sencure and Fisher & Paykel, and is Chair of Group 2.2 of ERS Assembly 2. C. Ribeiro reports a speaking fee from Vitalair, and support for attending meetings from Vitalair, Nippon, Vivisol, Linde and Novartis. T. Tonia acted as an ERS methodologist and reports no further conflicts of interest. C. Schöbel reports research grants from the German Joint Federal Committee, German Federal Ministry of Health, and German Federal Ministry of Education and Research, consulting fees from AstraZeneca, Chiesi, Idorsia, Inspire, Lilly, ResMed, ZOLL and Bioprojet, payment for lectures from AstraZeneca, Chiesi, Inspire, MSD, ResMed, BMS, Idorsia, Memetor, Lilly and ZOLL, and is board member of the German Sleep Society and German Society for Telemedicine, and working group member of the German Society for Internal Medicine, German Respiratory Society and the working group Cardiovascular Sleep Medicine of the German Cardiac Society. A. Özsancak Uğurlu reports a fee for attending a meeting from AstraZeneca (ERS 2024 online), and reports being National Representative for IRC and coordinator of the Turkish Respiratory Coalition (unpaid). J-C. Borel reports consulting fees from AGIR à dom, French Homecare provider, and ICADOM, a contract research organisation. M. Patout reports research grants from Fisher & Paykel, ResMed and Asten Santé, consulting fees from Philips, ResMed, Asten Santé, GSK, Air Liquide Medical and Isis, honoraria for lectures from Philips, ResMed, SOS Oxygene, Chiesi, Löwenstein, Bastide Medical, Elivie, Asten Santé, Air Liquide Medical, Antadir, Jazz Pharmaceutical, Fisher & Paykel, Orkyn and Sanofi, support for meeting attendance from Asten Santé, Vitalair and Sonofi, participation in advisory boards for ResMed, Sanofi, Philips and Asten Santé, stock from Kernel Biomedical, and receipt of equipment from Philips, ResMed and Fisher & Paykel. B. Ergan reports a consulting fee from Breas, and support for attending a meeting from Fisher & Paykel. C. Carlin reports an unrestricted investigator initiated research award (to institution) from ResMed, advisory board and speaker fees from ResMed, and meeting support and speaker fees from Fisher & Paykel. P. Murphy reports grants to institution from Breas, Philips, ResMed, GSK and Fisher & Paykel, payment for lectures from Philips, ResMed, Fisher & Paykel, Breas, Löwenstein, Santhera, GSK and Chiesi, support for attending meetings from Philips, ResMed, Fisher & Paykel, Breas and Löwenstein, and participation on an advisory board for ResMed. R. Dellacà reports a patent on the automatic detection of tidal expiratory flow limitation, owned by his institution, which was licensed to Philips for the automatic tailoring of PEEP in non-invasive ventilation. The patent (and license) expired in 2023. The licensed technology was unrelated to the manuscript's content. M. Vitacca reports payment for lectures from AstraZeneca, GSK, Menarini, Vivisol and Chiesi. C. Crimi reports speaking fees from Fisher & Paykel, Vitalair, Philips, ResMed, Sanofi, GSK, Aerogen and AstraZeneca, a patent pending (number 102023000013077) not discussed in the present work, and participation on advisory boards for Vitalair and Aerogen (occasional). The remaining authors have no potential conflicts of interest to disclose.

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