Bipap a30

Patients randomised to in-hospital initiation were initiated on chronic NIV according to the regular procedures on our pulmonary ward. We used a bilevel positive airway pressure (BiPAP)-set ventilator (BiPAP A40 and BiPAP A30, Philips Respironics, Murrysville, Pennsylvania, USA) and adjusted the settings to achieve normocapnia during the night or at least a reduction in nocturnal mean PtCO₂of 20% compared with the first night of spontaneous breathing.29 (link) The initiation period was finished and the patient was discharged home once he or she could sleep at least 6 consecutive hours with the ventilator and the gas exchange goals were achieved. When necessary, our specialised nurse joined the patients at home to instal the ventilator.

Patients randomised to home initiation were initiated on chronic NIV completely at their home, using telemedicine. Ventilator data were retrieved via a GPRS system clicked on the back of the ventilator (BiPAP A40 and BiPAP A30, Philips Respironics), which sent data to an online platform (Encore Anywhere, Philips Respironics). Changes in ventilator settings could be made remotely. Also, PtCO₂ was measured (SenTec DM, Software V-STATS V.4.0, SenTec AG, Therwil, Switzerland) and these data were retrieved remotely via a high-end ambulatory remote monitoring device (Dyna-vision, Techmedic International, Broek op Langedijk, the Netherlands). The specialised nurse visited the patient at day 1 to instal the equipment, explain all procedures, and to practice with NIV, and the last day to return the telemedicine/measurement devices and finish the initiation period. For a detailed explanation of the home initiation, see online repository.

Study participants were invited to the outpatient clinic once. Patients were fitted with appropriately sized nose mask and were instructed to ensure their mouths remained closed during CPAP/BiPAP application to prevent leakage. A short protocol (±20 min) was followed to acclimatise the participant with CPAP and BiPAP on the ventilator (BiPAP A30, Philips Respironics, Murrysville, PA).
After the acclimatisation protocol, the following settings were administered with room air for 10 min each, with 5 min spontaneous breathing in between: baseline (spontaneous breathing without CPAP/BiPAP), CPAP with a level of 5, 10 and 15 cmH₂O (CPAP-5, CPAP-10 and CPAP-15, respectively) and BiPAP with an inspiratory pressure of 14 cmH₂O and expiratory pressure of 10 cmH₂O with a lower (7 breaths/min) and higher (1 breath/min above the spontaneous breathing frequency) back-up respiratory rate (BURR). The spontaneous breathing frequency was determined while administering BiPAP with the lower BURR. Initially, the BURR during BiPAP with a higher BURR was set at 1 breath per minute above this established spontaneous breathing frequency, with the option for adjustment in case the patient continued to initiate breaths.