Wearable Ventilators: A Noninvasive Solution?
Portable ventilators are helping people with chronic respiratory diseases get some much needed exercise.
By Kathleen McKillip, MS, OTR/L, CareOne at Evesham
Advance Healthcare Network Posted on: October 19, 2015
Treating patients suffering from chronic obstructive pulmonary disease (COPD) with comorbidities represents an historic challenge not just for respiratory therapists, but all healthcare providers. It is well-documented that ambulation in these patients helps improve symptoms and ultimately may substantially reduce further complications while improving overall quality of life.
Data show that patients who engage in physical activity for two hours a week have fewer hospital admissions and their respiratory mortality rates are 30-40 percent lower.1 Outdoor activity increases four-year survival rates for patients to 35 percent, compared to 15 percent for those who are oxygen dependent.
Research has also demonstrated that for every 0.14 decrease in physical activity level (PAL) – which is measured by step count calculated by a multisensory armband – the relative risk of death is more than doubled.2
According to the World Health Organization, a PAL of 1.70 defines an active person. 1.40 to 1.69 defines a sedentary person and, 1.40 or below defines a very inactive person. While these data are compelling, unfortunately (and frustratingly for healthcare providers) the patients who could benefit most from exercise are oftentimes the least mobile.
Although non-invasive ventilation has historically been conclusively linked to improved exercise outcomes, the devices used in these studies were intrusive, uncomfortable, and too heavy to be considered practical for ambulatory use.3
I practice at CareOne at Evesham, a skilled nursing facility and healthcare provider in Marlton, New Jersey offering a spectrum of living accommodations and health services including post-hospital, sub-acute specialty programs in respiratory care. A 48 year-old patient named Debra was recently admitted to us, presenting with acute respiratory failure primarily caused by COPD. Comorbidities included coronary artery disease (CAD), hypertension, end stage liver disease (ESLD) and aortic stenosis.
Debra had a long history of pulmonary compromise and prior to her entry to CareOne, she led a largely sedentary lifestyle, though she was occasionally able to ambulate for short periods of time with the assistance of portable oxygen. She was unable, however, to tolerate extended periods of ambulation and as a result, she was severely limited in her abilities to engage in daily routine activities.
“Debra was extremely limited by her respiratory conditions and was not able to maintain a normal routine required for daily independent living,” said Maureen Transue, OTR/L. “Unfortunately, the inability to exercise led to exacerbations in her other comorbidities, so it was critical that we identified an appropriate intervention that would enable improved mobility outcomes.”
Prior to therapeutic intervention, Debra was receiving 6L of continuous oxygen with extremely limited mobility due to high oxygen consumption needs. At rest, her O2 saturation was 91 percent while seated, with heart and respiratory rates of 120 beats per minute and 18 breaths per minute, respectively. When ambulatory, her O2 saturation decreased to 86 percent following a 25 foot walk test, with the same heart and respiratory rates observed while at rest.
Following Debra’s assessment, her care team began therapy using a noninvasive one-pound, palm-sized wearable noninvasive ventilator that delivered a high mixture of oxygen and air through an unobtrusive nasal interface, augmenting her spontaneous breath and reducing the work of breathing. Such a system can be used by oxygen dependent patients and has also received FDA clearance for use with a compressed air supply for non-oxygen dependent patients.
Following discharge, Debra has made remarkable improvements from her baseline evaluation. She is now able to walk 200 feet without an assistive device and climb up and down 12 steps with supervision (compared to only three steps using her previous regimen of oxygen-only therapy without ventilation support) and can transfer from bed to chair and use the bathroom independently.
Perhaps most importantly, the wearable ventilator, Breathe Technologies’ Non-Invasive Open Ventilation (NIOV) system, has enabled her to participate in longer periods of therapeutic exercise and activity to improve her overall strength and conditioning. Within our facility, adopting the system into routine practice has improved the overall quality of rehabilitation sessions and increased the total amount of therapy that our patients can tolerate.
Debra noted that the ventilator has completely improved her quality of life.
“Whereas before, I could only take a few steps, I’m now able to participate in activities that I hadn’t thought possible. Not only is my physical quality of life better, but my mental outlook is more positive and levels of anxiety and depression associated with my disease have decreased considerably.”
Kathleen McKillip, MS, OTR/L, is Campus Director of Rehabilitation Services, CareOne at Evesham in Marlton, New Jersey.
1. J Garcia-Aymerich et al “Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study.” Thorax 2006;61:772-778