Ongoing monitoring and optimisation of NIV
Monitoring adherence/efficacy of NIV
To receive maximum benefit from the NIV, patients must adhere to it and achieve effective ventilation.
Monitoring people living with MND
How do you currently monitor people living with motor neurone disease (MND) who are using non-invasive ventilation (NIV)?
In the following videos, Physiotherapists Rosie Whitehead and Matt Cox describe the different ways of monitoring people living with MND using NIV and the importance of these.
Monitoring should happen at least every three months but ideally as needed. It should assess adherence, tolerance and effectiveness and should involve a variety of methods such as telephone calls, face-to-face assessments or home visits, and patient diaries.
The use of telemonitoring using the ventilator plus a modem should be considered for all patients as a way to gain rapid real-time objective measures of adherence and effectiveness and reduce the need for face-to-face contact and travelling by the patient to the clinic.
Physiological measures should be used to supplement symptom report. After initiation, overnight oximetry should also be used to assess the effectiveness of the ventilation in the following circumstances:
Once patients report adherence of at least four hours.
When the patient complains of new symptoms suggestive of inadequate ventilation, the ventilator settings or interface have been adjusted.
Following this, overnight oximetry should be performed at least every three to six months.
In the following clip, Rosie describes the importance of the community teams in feeding back any problems to the respiratory team so they can rectify them and ensure that patients are adhering well to the ventilator and achieving effective ventilation.
Will you make any changes to the way you monitor people living with MND using NIV in the future?
Good practice points
Healthcare professionals should use a range of measures to monitor patients using NIV including symptom reports, physiological measures, telemonitoring and data downloads from the machine.
Overnight oximetry should be used to assess the effectiveness of the NIV once patients report adherence of at least four hours or when the patient complains of new symptoms.
Healthcare professionals should provide patients and their family members, information on who to contact if they have any problems.