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Research ArticleOriginal Research

Measuring Adherence to Long-Term Noninvasive Ventilation

Caroline Chao, David J Berlowitz, Mark E Howard, Linda Rautela, Luke A McDonald and Liam M Hannan
Respiratory Care September 2021, 66 (9) 1469-1476; DOI: https://doi.org/10.4187/respcare.08745
Caroline Chao
Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.
Department of Physiotherapy, Austin Health, Heidelberg, Victoria, Australia.
Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.
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  • For correspondence: [email protected]
David J Berlowitz
Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.
Department of Physiotherapy, Austin Health, Heidelberg, Victoria, Australia.
Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.
The University of Melbourne, Parkville, Victoria, Australia.
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Mark E Howard
Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.
Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.
The University of Melbourne, Parkville, Victoria, Australia.
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Linda Rautela
Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.
Department of Physiotherapy, Austin Health, Heidelberg, Victoria, Australia.
Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.
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Luke A McDonald
Department of Physiotherapy, Austin Health, Heidelberg, Victoria, Australia.
Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.
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Liam M Hannan
Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.
The University of Melbourne, Parkville, Victoria, Australia.
Department of Respiratory Medicine, Northern Health, Epping, Victoria, Australia.
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Abstract

BACKGROUND: Obtaining benefits from long-term noninvasive ventilation (NIV) relies on achieving adequate adherence to treatment. Reported adherence to NIV is variable and could be influenced by high-volume users and attrition of nonusers and those who die. This observational study aimed to describe patterns of use and adherence rates in new unselected users of NIV.

METHODS: All adults (> 18 y old) commencing long-term NIV were consecutively enrolled and followed for 6 months. Ventilator data were manually downloaded from devices and usage (minutes per day) was collected. Subjects were categorized into adherent users (≥ 4 h/d) and nonadherent users (< 4 h/d).

RESULTS: Data were obtained from 86 subjects. Most (65%) had motor neuron disease, and most commenced NIV in an out-patient setting (72%). At one month after NIV implementation, overall average daily use was 302.1 min/d and categorical adherence was 57%. At 6 months or prior to death, overall average daily use increased (388.7 min/d), but categorical adherence was similar (62%). The majority of subjects (84%) remained in the same adherence category from their first month to their sixth month of use or death. Individuals with motor neuron disease demonstrated significantly lower rates of adherence compared to the rest of the cohort at 1 month (48% vs 73%, P = .03). In those who died within the study period (n = 19, all with motor neuron disease), this difference persisted to death (42% at death vs 73% at 6 months, P = .032).

CONCLUSIONS: Average daily usage may conceal true prevalence of adherence or nonadherence to NIV within a population. Reporting both average daily use data and categorical adherence rates (using a threshold of 4 h/d) may improve transparency of reported outcomes from clinical trials and identifies a therapeutic target for home mechanical ventilation services for quality improvement.

  • noninvasive ventilation
  • patient compliance
  • respiratory insufficiency
  • treatment adherence

Footnotes

  • Correspondence: Caroline Chao MPhysio-Cardioresp PT, Austin Health, Department of Physiotherapy, 145 Studley Road, Heidelberg, Victoria, 3084, Australia. E-mail: caroline.chao{at}austin.org.au
  • Ms Chao presented a version of this paper at the European Respiratory Society’s Respiratory Failure and Mechanical Ventilation Conference, held February 13–15, 2020, in Berlin, Germany.

  • Dr Howard has disclosed a relationship with Philips Respironics. The other authors have disclosed no conflicts of interest.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (9)
Respiratory Care
Vol. 66, Issue 9
1 Sep 2021
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Measuring Adherence to Long-Term Noninvasive Ventilation
Caroline Chao, David J Berlowitz, Mark E Howard, Linda Rautela, Luke A McDonald, Liam M Hannan
Respiratory Care Sep 2021, 66 (9) 1469-1476; DOI: 10.4187/respcare.08745

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Measuring Adherence to Long-Term Noninvasive Ventilation
Caroline Chao, David J Berlowitz, Mark E Howard, Linda Rautela, Luke A McDonald, Liam M Hannan
Respiratory Care Sep 2021, 66 (9) 1469-1476; DOI: 10.4187/respcare.08745
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Keywords

  • noninvasive ventilation
  • patient compliance
  • respiratory insufficiency
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