Research

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Mechanical ventilation has, since its introduction into clinical practice, undergone a major evolution from controlled ventilation to various modes of assisted ventilation. Neurally adjusted ventilatory assist (NAVA) is the newest development. The implementation of NAVA requires the introduction of …

Neurally adjusted ventilatory assist (NAVA) is a mode of ventilation in which both the timing and degree of ventilatory assist are controlled by the patient. Since NAVA uses the diaphragm electrical activity (Edi) as the controller signal, it is possible to deliver synchronized non-invasive NAVA (NI …

Background The ever-increasing number of patients diagnosed with obstructive sleep apnoea (OSA) and treated by long-term continuous positive airway pressure (CPAP) overstretches conventional follow-up pathways. New approaches to the management of CPAP-treated patient follow-up are needed to strike a balance between remote monitoring through digital technologies and in-person patient-healthcare-professional contacts. Focusing on the reshaping of the management of care pathways of CPAP-treated patients, with a specific focus on telemonitoring platforms, we aimed to review the evidence on how digital medicine and artificial intelligence (AI) tools are facilitating patient phenotyping and triage, risk stratification and the allocation of resources between the various healthcare professionals for an optimal follow-up of CPAP-treated patients. Phenotyping OSA is a heterogeneous condition with diverse phenotypes differing in symptoms, comorbidities, demographics, lifestyle and socioeconomic context. Different phenotypes are associated with different CPAP adherence patterns and differing long-term prognosis. This diversity demands greater plurality in management pathways with different types and levels of support to ensure treatment adherence and risk reduction for patients while easing the burden on health services. In multidimensional phenotyping, we discuss alternatives to the apnoea hypopnoea index (AHI) as a measure of OSA severity. Then we consider risk stratification taking advantage of the wealth of CPAP monitoring data already available in databases that can now be exploited using AI and machine learning to direct (stratify) patients into appropriate follow-up management pathways. Integrated care clinics for high-risk patients We look at the role of integrated OSA care clinics particularly for the management of high-risk patients with low adherence and progression of comorbidities. Here, multidisciplinary teams might propose comorbidity management, and the use of connected wearable devices for long-term monitoring of physical activity, along with remote CPAP monitoring. Remote management pathways The pros and cons of remote management pathways to replace in-person follow-up visits are considered, including the need to re-evaluate CPAP-device reimbursement policies in some countries. While remote CPAP monitoring has become the cornerstone of follow-up providing information on adherence and efficacy, the processing of alerts needs to be improved, particularly regarding mask changes and early detection of CPAP failures. Challenges The implementation of CPAP monitoring alone, as well as its extension to multimodal monitoring, can present challenges that remain to be addressed (eg, access to digital care). The extent and components of remote follow-up must be adapted to each specific OSA phenotype. Finally, we give examples of certain patient phenotypes (eg, comorbid insomnia with OSA) with specific follow-up requirements, for which remote (even multimodal) monitoring alone has limitations and the intervention of both sleep specialists and/or their colleagues from other disciplines is needed. Conclusion Appropriately tailored combined digital and in-person CPAP follow-up pathways would present advantages both for patients with OSA and healthcare services.

In this cross-sectional study of adults eligible for cancer screening, findings revealed notable variations in screening patterns by both screening type and sex. Given that these risks may not always align with patient-centered social needs, further research focusing on specific target populations i …

The study was approved by the research overview of the Capital of Denmark and the Center for Health.

The University of Colorado Medicine's population health initiative provided mixed results on medication adherence metrics. Electronic health record messaging provided insight into ways to improve the intervention to better engage and assist patients.

Reverse triggering is an underdiagnosed form of patient-ventilator asynchrony in which a passive ventilator-delivered breath triggers a neural response resulting in involuntary patient effort and diaphragmatic contraction. Reverse triggering may significantly impact patient outcomes, and the unique …

The failure of noninvasive ventilatory support to reduce respiratory effort may exacerbate pulmonary injury in patients with early COVID-19 pneumonia. HFNOT reduces lung strain and achieves similar oxygenation to CPAP/NIV. Invasive mechanical ventilation may be less injurious than noninvasive suppor …

To investigate the effect of positive end-expiratory pressure (PEEP) guided by transpulmonary pressure or with maximum oxygenation-directed PEEP on lung injury in a porcine model of acute respiratory distress syndrome (ARDS). The porcine model of ARDS was induced in 12 standard pigs by intratracheal …

(www.crd.york.ac.uk/prospero) under ID CRD42021227231.

We assessed the effects of varying doses of remifentanil on respiratory drive and timing in patients receiving Pressure Support Ventilation (PSV) and Neurally Adjusted Ventilatory Assist (NAVA). Four incrementing remifentanil doses were randomly administered to thirteen intubated patients (0.03, 0.0 …