Optimal NIV Medicare Access Promotion: Patients With COPD
| Autor: | Nicholas S. Hill, Gerard J. Criner, Richard D. Branson, Bartolome R. Celli, Neil R. MacIntyre, Amen Sergew, Peter C. Gay, Robert L. Owens, Lisa F. Wolfe, Joshua O. Benditt, Loutfi S. Aboussouan, John M. Coleman, Dean R. Hess, Timothy I. Morgenthaler, Atul Malhotra, Richard B. Berry, Karin G. Johnson, Marc I. Raphaelson, Babak Mokhlesi, Christine H. Won, Bernardo J. Selim, Barry J. Make, Bernie Y. Sunwoo, Nancy A. Collop, Susheel P. Patil, Alejandro D. Chediak, Eric J. Olson, Kunwar Praveen Vohra |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
Obesity hypoventilation syndrome medicine.medical_specialty Central sleep apnea business.industry medicine.medical_treatment Sleep apnea Critical Care and Intensive Care Medicine medicine.disease Sleep medicine Apnea–hypopnea index Oxygen therapy Positive airway pressure medicine Continuous positive airway pressure Cardiology and Cardiovascular Medicine business Intensive care medicine |
| Zdroj: | Chest. 160:e389-e397 |
| ISSN: | 0012-3692 |
| DOI: | 10.1016/j.chest.2021.06.082 |
| Popis: | This document summarizes suggestions of the central sleep apnea (CSA) Technical Expert Panel working group. This paper shares our vision for bringing the right device to the right patient at the right time. For patients with CSA, current coverage criteria do not align with guideline treatment recommendations. For example, CPAP and oxygen therapy are recommended but not covered for CSA. On the other hand, bilevel positive airway pressure (BPAP) without a backup rate may be a covered therapy for OSA, but it may worsen CSA. Narrow coverage criteria that require near elimination of obstructive breathing events on CPAP or BPAP in the spontaneous mode, even if at poorly tolerated pressure levels, may preclude therapy with BPAP with backup rate or adaptive servoventilation, even when those devices provide demonstrably better therapy. CSA is a dynamic disorder that may require different treatments over time, sometimes switching from one device to another; an example is switching from BPAP with backup rate to an adaptive servoventilation with automatic end-expiratory pressure adjustments, which may not be covered. To address these challenges, we suggest several changes to the coverage determinations, including: (1) a single simplified initial and continuing coverage definition of CSA that aligns with OSA; (2) removal of hypoventilation terminology from coverage criteria for CSA; (3) all effective therapies for CSA should be covered, including oxygen and all PAP devices with or without backup rates or servo-mechanisms; and (4) patients shown to have a suboptimal response to one PAP device should be allowed to add oxygen or change to another PAP device with different capabilities if shown to be effective with testing. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|