Telemedicine in home mechanical ventilation: promise, pitfalls and path forward

Abstract

Home mechanical ventilation (HMV) is a life-saving treatment for patients with chronic respiratory failure due to different underlying diseases.1–4 Striving for value-based care, that is, high-quality care with optimal use of resources, telemedicine for ventilator-dependent patients holds promise.5 Telemedicine might improve efficiency and quality of HMV care, empower patients and informal caregivers,6–8 enable care at home and broaden access to care, particularly in resource-constrained settings. Telemedicine ideally offers the potential to reduce inpatient care needs,9–11 lower healthcare costs10 11 and foster a more patient-centred approach. Yet, as its adoption increases, important questions arise regarding its actual effectiveness, feasibility and generalisability in chronic respiratory care. In this issue of Thorax , Prigent and colleagues report the results of the eVENT study, a randomised controlled trial evaluating the role of telemonitoring and remote support in the long-term follow-up of patients with obesity hypoventilation syndrome (OHS) and overlap syndrome with chronic obstructive pulmonary disease (COPD) treated with home non-invasive ventilation (NIV).12 Their work highlights both the potential and limitations of integrating telemedicine into ventilatory care. Interestingly, although mean nocturnal transcutaneous carbon dioxide pressure (PtCO2) on home NIV at 6 months ( primary outcome ) did not differ significantly between the telemonitoring and usual care groups, daytime arterial partial pressure of carbon dioxide (PaCO2) was significantly lower in the telemonitoring versus the usual care follow-up group (41.7±6.8 vs 46.2±3.5 mm Hg). The discrepancy between nocturnal PtCO₂ and daytime PaCO₂ warrants important consideration. While PtCO₂ is a direct …