The following is the summary of “Noninvasive Ventilation Automated Technologies: A Bench Evaluation of Device Responses to Sleep-Related Respiratory Events” published in the January 2023 issue of Respiratory Care January by Delorme, et al.

In most cases of persistent respiratory failure, noninvasive ventilation (NIV) is the gold standard of care. To maintain upper airway patency and prevent hypoventilation, NIV settings must be titrated. Domiciliary NIV may be started and monitored more easily with automatic pressure support (PS) and expiratory positive airway pressure (EPAP). However, it is not yet known if the automatic-adjustment algorithms built into existing devices can reliably detect, respond to, and score typical sleep-related respiratory episodes.  A bench was set up to imitate central hypopnea (CH), central apnea (CA), obstructive hypopnea (OH), and obstructive apnea (OA). 

About 4 home ventilators were tested, and their auto-PS and auto-EPAP settings were analyzed. The results showed that all 4 devices raised PS in CH, CA, and OH. However, PS correction varied greatly in magnitude, with tidal volumes within 100 ± 20% of the objective being given by just 3 devices for CH, one for CA, and one for OH. There were two devices that boosted EPAP for OH, three for OA, and one that boosted EPAP for both OH and OA. When simulated CA and OH were applied to all devices, only 2 devices recorded residual hypopnea. 

There was no activity recorded by one of the devices. This study found that current NIV devices significantly varied in how they responded to and reported on standardized sleep-related respiratory episodes. Additional development of embedded NIV algorithms is required to enable NIV initiation and monitoring outside of a controlled laboratory setting.