[Noninvasive ventilation. The 2015 guidelines from the Groupe Assistance Ventilatoire (GAV) of the Société de Pneumologie de Langue Française (SPLF)]. / Ventilation non invasive. Les conseils 2015 du Groupe assistance ventilatoire (GAV) de la Société de pneumologie de langue française (SPLF).

A task force issued from the Groupe Assistance Ventilatoire (GAV) of the Société de Pneumologie de Langue Française (SPLF) was committed to develop a series of expert advice concerning various practical topics related to long-term non invasive ventilation by applying the Choosing Wisely® methodology. Three topics were selected: monitoring of noninvasive ventilation, the interpretation of data obtained from built-in devices coupled to home ventilators and the role of hybrid modes (target volume with variable pressure support. For each topic, the experts have developed practical tips based on a comprehensive analysis of recent insights and evidence from the literature and from clinical experience.

[Proposal for a systematic analysis of polygraphy or polysomnography for identifying and scoring abnormal events occurring during non-invasive ventilation]. / Proposition pour une analyse systématique de la polygraphie et de la polysomnographie afin d'identifier les évènements anormaux survenant pendant la ventilation non invasive.

Non-invasive ventilation (NIV) is recognised as an effective treatment for chronic hypercapnic respiratory failure. Monitoring NIV during sleep may be preferable to daytime assessment. This paper reports the findings of an international consensus group, which systematically analysed nocturnal polygraphic or polysomnographic tracings recorded with either volume-cycled or pressure-cycled ventilators. A systematic description of nocturnal respiratory events, which occur during NIV, is proposed: leaks, obstruction at different levels of the upper airway (glottis and/or pharynx), with or without decrease of respiratory drive and asynchrony.

[Ventilator modes and settings during non-invasive ventilation: effects on respiratory events and implications for their identification. 2011]. / Modes ventilatoires et réglages en ventilation non invasive : retentissement sur les évènements respiratoires et implications dans leur identification.

Compared with invasive ventilation, non-invasive ventilation (NIV) has two unique characteristics: its non-hermetic nature and the fact that the ventilator-lung assembly cannot be considered as a single-compartment model because of the presence of variable resistance represented by the upper airways. When NIV is initiated, the ventilator settings are determined empirically based on clinical evaluation and blood gas variations. However, NIV is predominantly applied during sleep. Consequently, to assess overnight patient-machine "agreement" and efficacy of ventilation, more specific and sophisticated monitoring is needed. The effectiveness of NIV might therefore be more correctly assessed by sleep studies than by daytime assessment. The simplest monitoring can be done from flow and pressure curves from the mask or the ventilator circuit. Examination of these tracings can give useful information to evaluate if the settings chosen by the operator were the right ones for that patient. However, as NIV allows a large range of ventilatory parameters and settings, it is mandatory to have information about this to better understand patient-ventilator interaction. Ventilatory modality, mode of triggering, pressurization slope, use or not of positive end expiratory pressure and type of exhalation as well as ventilator performances may all have physiological consequences. Leaks and upper airway resistance variations may, in turn, modify these patterns. This article discusses the equipment available for NIV, analyses the effect of different ventilator modes and settings and of exhalation and connecting circuits on ventilatory traces and gives the background necessary to understand their impact on nocturnal monitoring of NIV.

Proposal for a systematic analysis of polygraphy or polysomnography for identifying and scoring abnormal events occurring during non-invasive ventilation.

Non-invasive ventilation (NIV) is recognised as an effective treatment for chronic hypercapnic respiratory failure. Monitoring NIV during sleep may be preferable to daytime assessment. This paper reports the findings of an international consensus group which systematically analysed nocturnal polygraphic or polysomnographic tracings recorded with either volume-cycled or pressure-cycled ventilators. A systematic description of nocturnal respiratory events which occur during NIV is proposed: leaks, obstruction at different levels of the upper airway (glottis and/or pharynx), with or without decrease of respiratory drive and asynchrony.

[Initiation of domiciliary non-invasive ventilation: proposals of the Casavni working party]. / Mise en route d'une ventilation non invasive au domicile: propositions du groupe de travail Casavni.

INTRODUCTION: In France, there are no good practice guidelines or a regulatory framework for the initiation of long term non-invasive ventilation (NIV). METHODS: The ANTADIR federation set up a working party to examine the feasibility of new methods of initiation of NIV and to consider the possibility of initiation in the home. Two problems were considered: (1) logistical and technical requirements, (2) the responsibilities of the professions involved and the regulatory framework. RESULTS: Clinical effectiveness, improvement in quality of life and adherence to treatment are similar whether NIV is initiated in hospital or at home. Domiciliary management is possible only when the patient is clinically stable. It should be undertaken by a competent physician or, on medical prescription, by a physiotherapist. A nurse or trained technician may check the apparatus but should not initiate NIV alone. Installation of domiciliary NIV should be considered under the following conditions: patients with spontaneous ventilation, availability of urgent assistance and appropriate family support. Close surveillance of the quality of ventilation is necessary, whether in hospital or at home. For the initiation of domiciliary NIV each professional involved needs a clear understanding of his/her role. CONCLUSION: Academic societies should propose good practice guidelines for the initiation of NIV. Domiciliary initiation is possible under certain conditions and the results are as good as those obtained in hospital.

Compliance with and effectiveness of adaptive servoventilation versus continuous positive airway pressure in the treatment of Cheyne-Stokes respiration in heart failure over a six month period.

OBJECTIVE: To compare compliance with and effectiveness of adaptive servoventilation (ASV) versus continuous positive airway pressure (CPAP) in patients with the central sleep apnoea syndrome (CSA) with Cheyne-Stokes respiration (CSR) and with congestive heart failure in terms of the apnoea-hypopnoea index (AHI), quality of life, and left ventricular ejection fraction (LVEF) over six months. METHODS: 25 patients (age 28-80 years, New York Heart Association (NYHA) class II-IV) with stable congestive heart failure and CSA-CSR were randomly assigned to either CPAP or ASV. At inclusion, both groups were comparable for NYHA class, LVEF, medical treatment, body mass index, and CSA-CSR. RESULTS: Both ASV and CPAP decreased the AHI but, noticeably, only ASV completely corrected CSA-CSR, with AHI below 10/h. At three months, compliance was comparable between ASV and CPAP; however, at six months compliance with CPAP was significantly less than with ASV. At six months, the improvement in quality of life was higher with ASV and only ASV induced a significant increase in LVEF. CONCLUSION: These results suggest that patients with CSA-CSR may receive greater benefit from treatment with ASV than with CPAP.

[Education of the families of patients receiving domiciliary ventilation]. / Information des families des patients recevant une ventilation à domicile.

INTRODUCTION: Domiciliary ventilation involves the establishment of a network of hospital and community based medical and paramedical carers, together with the technical support of the apparatus. Within this network the family form a pivot and their education should therefore be integrated into the setting up and maintenance of all cases of domiciliary ventilation. BACKGROUND: Currently this education is neither formalised nor the object of any consensus (with the exception of paediatric departments who, for the most part, provide training for the family, in partnership with the home care provider, in the hospital environment, before a ventilated child is returned home). Most commonly the information packages, medical and technical, are distributed by the various contributors without coordination or validation. The family find themselves in the midst of a network within which they do not understand the role of each member and therefore risk being unable to find the information or knowledge that they may need. VIEWPOINT: Domiciliary ventilation, particularly non-invasive ventilation, is increasing and the main role of the family, which should be regarded in the broadest sense as everyone involved in the daily activities of the home, is to help the patient accept a treatment that is restricting in the long term. Their education should be integrated, as with the therapeutic education of the patient, into an educational project with objectives, learning tools, and validation of the knowledge acquired. This project should be result of co-operation between all the members of the care network and lead to the production supportive documentation. CONCLUSIONS: Better education of families should lead to a reduction, or better still prevention, of the incidents that are inherent in the use of assisted ventilation equipment and improve the quality of life of the patient and his family in a secure environment.