Titration and Follow-up for Home Noninvasive Positive Pressure Ventilation in Chronic Obstructive Pulmonary Disease: the potential role of Tele-monitoring and the Internet of things.

INTRODUCTION Home noninvasive positive pressure ventilation (NIPPV) has become a well-established treatment for stable hypercapnic chronic obstructive pulmonary disease (COPD) patients. There are still other challenges including appropriate titration of ventilator parameters, adequacy of follow-up, monitoring and management at home to ensure effectiveness and security, and to improve quality of life. The Internet of Things (IoT) is the name given to the network of devices and other "things" with built-in sensors, software, electronics, and network connectivity, which can communicate these objects over wireless networks and then send data to a cloud platform. Reliable tele-monitoring and transmission of clinical parameters from home to hospitals has prompted the development of IoT-based home NIPPV. OBJECTIVES This review provides an overview of titration and follow-up of home NIPPV and focus on different technologies, modalities, management, and cost-effectiveness used in IoT-based tele-monitoring of home mechanical ventilation. DATA SOURCE Literature search of Web of Science, PubMed and EMBASE was made to find relevant articles about tele-monitoring and the Internet of things in home mechanical ventilation over the last 15 years. We used the following search terms: NIPPV, COPD, home mechanical ventilation, telemedicine, tele-monitoring and management. CONCLUSION IoT-based management of home NIPPV, such as home titration and follow-up with the use of tele-monitoring, are emerging and yielding positive findings. However, clear conclusions based on RCT of tele-monitoring in COPD patients with NIPPV at home are only a few and large-scale multicenter studies are required for replication and further validation.