Telemonitoring for Home-assisted Ventilation: A Narrative Review.
Telemonitoring for Home-assisted Ventilation: A Narrative Review.
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DOI：
10.1513/annalsats.202101-033cme
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发表时间：
2021-11
影响因子：
8.3
通讯作者：
Hansen-Flaschen J
中科院分区：
文献类型：
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作者：
Ackrivo J;Elman L;Hansen-Flaschen J
最近出现的远程呼吸机远程监护有可能给美国和其他地方的家庭辅助呼吸机护理带来革命性的变化。家庭通气机(即呼吸辅助设备和便携式呼吸机)现在可以将使用和性能数据无线传输到基于云的网络服务器，供参与的临床医生远程访问。在这篇聚焦回顾中，我们提供现有技术的最新进展，建议临床护理和研究的实际应用，并回顾支持文献。远程监控允许及早查看数据、改进设备设置以优化通风功能，以及在初始设置后出现新问题时进行故障排除。来自家庭肺活量测量和非侵入性测量的血气压力的数据可以补充呼吸机数据以反映生理反应。承认缺乏已发表的结果研究，远程远程监测可能是减少急诊室就诊、紧急诊所预约和住院的一种经济有效的策略。欧洲正在进行的临床试验旨在扩大这项快速发展的技术的好处。然而，几个障碍可能会阻碍广泛的实施，特别是在美国。临床医生必须熟悉每个呼吸机制造商的专有软件，以安全地利用这项技术来改善护理。法律和伦理方面的考虑威胁到临床医生的利益。医疗保险付款人必须调整补偿计划，以激励临床医生和耐用医疗设备公司提供这项耗时的服务。队列水平的呼吸机数据将促进多中心临床试验，重点是改善这一脆弱人群的呼吸护理。
The recent advent of remote ventilator telemonitoring has the potential to revolutionize home-assisted ventilation care in the United States and elsewhere. Home ventilation machines (i.e., respiratory assist devices and portable ventilators) can now wirelessly transmit usage and performance data to cloud-based web servers for remote access by participating clinicians. In this Focused Review, we provide an update on available technology, suggest practical applications for clinical care and research, and review supporting literature. Remote monitoring permits early data review, refinement of device settings to optimize ventilatory function, and troubleshooting if a new problem arises after initial setup. Data from home spirometry and noninvasively measured blood gas tensions can complement ventilator data to reflect physiological response. Acknowledging a paucity of published outcome studies, remote telemonitoring may be a cost-effective strategy to reduce emergency room visits, urgent clinic appointments, and hospitalizations. Ongoing clinical trials in Europe aim to expand on the benefit of this rapidly evolving technology. However, several barriers may hinder widespread implementation, especially in the United States. Clinicians must familiarize themselves with each ventilator manufacturer’s proprietary software to safely leverage this technology for improving care. Legal and ethical considerations threaten clinician interest. Medical insurance payers must adapt a reimbursement scheme to incentivize clinicians and durable medical equipment companies to perform this time-consuming service. Cohort-level ventilator data will facilitate multicenter clinical trials focused on improving the respiratory care of this vulnerable population.