Pontier-Marchandise Sandrine, Texereau Joelle, Prigent Arnaud, Gonzalez-Bermejo Jésus, Rabec Claudio, Gagnadoux Frédéric, Letierce Alexia, Winck Joao Carlos
Department of Respiratory Medicine, Larrey Hospital, Toulouse University Hospital, Toulouse, France.
Lung Function & Respiratory Physiology Units, Cochin University Hospital, AP-HP, Paris, France; VitalAire, Air Liquide Healthcare, Bagneux, France.
Respir Med Res. 2023 Nov;84:101028. doi: 10.1016/j.resmer.2023.101028. Epub 2023 May 25.
The ETAPES program is a national telemedicine experiment conducted in France between 2018 and 2023 to investigate whether home non-invasive ventilation (NIV) telemonitoring improves healthcare pathways in patients with chronic respiratory failure (CRF) and impacts healthcare organization. The program provides a combination of therapeutic education and NIV telemonitoring with data processed by an algorithm generating alerts. The TELVENT study objective was to analyze the evolution of ventilation quality in patients included in the ETAPES program.
Multicentric cohort study on patients undergoing long-term NIV included in the ETAPES program between September 2018 and December 2020 and who did not refuse the use of their data for this research. Data were obtained from homecare provider databases. The primary endpoint was to attain successful NIV treatment, which was determined by a combination of daily NIV usage for > 4 h per day, low leaks, and a low apnea-hypopnea index (AHI) identified by the NIV device. Respiratory disability was assessed using the DIRECT questionnaire.
329 patients were included in the study of which 145 had COPD and 83 had started NIV and ETAPES within one-month delay. Approximately 25% of patients did not achieve the criteria for successful NIV at ETAPES entry. The proportion of patients with successful NIV treatment increased to 86.8% at six months (p = 0.003, Cochran-Armitage trend test) regardless of NIV history and continued to increase at 12 months in newly equipped NIV patients (93.8%, at month 12, p = 0.0026 for trend test). Over time, a significant increase in NIV use and compliance was observed, while AHI significantly decreased in the overall population. No significant decrease was observed for non-intentional leaks. Approximately 4.9 alerts were generated per patient per 6 months. Their number and type (low NIV use, high AHI or leaks) differed among patients based on their NIV history. Respiratory disability score decreased over time compared with baseline.
The TELVENT study highlights the importance of remote NIV monitoring to rapidly identify patients with unsuccessful ventilation. The combination of remote monitoring and therapeutic education may improve the quality of home NIV, especially in the first months of treatment.
ETAPES项目是2018年至2023年在法国开展的一项全国性远程医疗实验，旨在研究家庭无创通气（NIV）远程监测是否能改善慢性呼吸衰竭（CRF）患者的医疗路径并影响医疗组织。该项目提供治疗教育与NIV远程监测，并结合由算法处理数据以生成警报。TELVENT研究的目的是分析ETAPES项目中患者通气质量的变化情况。
对2018年9月至2020年12月纳入ETAPES项目且不拒绝将其数据用于本研究的长期接受NIV治疗的患者进行多中心队列研究。数据来自家庭护理提供者数据库。主要终点是实现成功的NIV治疗，这由每日NIV使用时间>4小时、低漏气量以及NIV设备识别的低呼吸暂停低通气指数（AHI）共同确定。使用DIRECT问卷评估呼吸功能障碍。
329例患者纳入研究，其中145例患有慢性阻塞性肺疾病（COPD），83例在1个月内开始使用NIV并参与ETAPES项目。约25%的患者在进入ETAPES项目时未达到成功NIV治疗的标准。无论NIV治疗史如何，成功进行NIV治疗的患者比例在6个月时增至86.8%（p = 0.003， Cochr an - Armitage趋势检验），新配备NIV设备的患者在12个月时继续增加（12个月时为93.8%，趋势检验p = 0.0026）。随着时间推移，观察到NIV使用和依从性显著增加，而总体人群的AHI显著降低。非故意漏气量未观察到显著下降。每位患者每6个月约产生4.9次警报。根据NIV治疗史不同患者的警报数量和类型（NIV使用量低、AHI高或漏气）有所差异。与基线相比，呼吸功能障碍评分随时间下降。
TELVENT研究强调了远程NIV监测对于快速识别通气不成功患者的重要性。远程监测与治疗教育相结合可能会改善家庭NIV的质量，尤其是在治疗的最初几个月。
