Invasive mechanical ventilation may not be the only alternative for individuals with chronic respiratory failure associated with COPD, obesity hypoventilation syndrome (OHS), or neuromuscular disease (NMD). All three are indications for noninvasive ventilation (NIV) in the hospital and at home.

“Current technology gives us NIV units not much bigger than a small cooler you can carry in one hand, sit on a walker seat, or hang from a wheelchair that provide most of the ventilation options you have in the hospital,” said Meredith Greer, MD, Assistant Professor of Medicine at Emory University School of Medicine. “This technology can significantly improve your patients’ quality of life and survival. If you can optimize NIV settings, you can potentially reduce risk of recurrent hospital admissions, intubation, and tracheostomy.”

Dr. Greer will chair the panel discussion, Right Patient, Right Settings: Targeted Strategies for Managing NIV in COPD, OHS, and NMD, on Tuesday, from 10:30 am to 11:30 am, in Room 320 of the convention center. The session will explore proven NIV strategies and tips for COPD, OHS, and NMD.

NIV technology isn’t new, Dr. Greer said, but even sleep specialists may not be familiar with the engineering that goes into advanced modes and settings and the different approaches to NIV that can benefit different causes of respiratory failure.

“Clinicians may not commonly care for patients with some of the conditions that can benefit from NIV, and not everyone has an advanced NIV expert at their institution,” Dr. Greer said. “This level of nuance is not really discussed anywhere else, not even in many fellowship programs. Understanding the distinct pathophysiologies of different types of respiratory failure, as well as the basic engineering of these machines and how they work, is tantamount to understanding how to program the settings correctly.”

Bernardo J. Selim, MD, FCCP, of Mayo Clinic, will present practical tips for the mechanics, modes, and algorithms in NIV. Alejandra Lastra, MD, FCCP, of the University of Chicago Medical Center, will focus on high-intensity NIV and other strategies in COPD. Dr. Greer will explore the unique pathophysiologic challenges of OHS and how to tailor NIV when CPAP is not enough. And Jeanette Brown, MD, PhD, FCCP, of the University of Utah, will focus on tips for optimizing NIV in NMD, such as trigger high and cycle low.

“These are all very different diseases,” Dr. Greer said. “Just for starters, not every elevated carbon dioxide is the same. If you have elevated CO₂ in COPD or emphysema, you have a very different issue than OHS, which is different from NMD. The same NIV machine may be appropriate for all three diseases, but the optimal settings vary by pathology. You can really make a difference in your patients’ lives by understanding how to optimize noninvasive ventilation.”

For a detailed flowchart based on the latest guideline that outlines an algorithm for initiation of NIV for adult patients with neuromuscular disease experiencing fatigue, headache, concentration/memory difficulty, and/or respiratory symptoms, visit CHEST’s website.