An improved telemedicine system for remote titration and optimization of Home Mechanical Ventilation

Home Mechanical Ventilation is applied to patients with different chronic respiratory diseases and, in order to be effective, it requires accurate individual titration. Nowadays this can be obtained only in the hospital during day or night visits, and this is associated with long waiting lists and high costs. The aim of this work was to realize and test a simple system that allows a remote titration of the ventilator at the patient's home by a physician at the hospital. The system is derived from the one we developed in a previous study. It is based on a simple and low cost embedded device with a mobile phone GPRS data network modem and a short-range wireless module, used to provide wireless connection with a pulse oxymeter. The device is connected to a mechanical ventilator and to an infrared webcam through USB ports. When the ventilator is in operation, the system acquires and stores data from it and from the pulse oxymeter. It also connects to Internet and waits for remote connections. The physician can connect and look at the patient's ventilator tracings, oxygen saturation and heart rate and, if needed, he can also ask for snapshots of the patient through the webcam. Based on this information, the physician can also change ventilator settings to titrate the ventilator parameters depending on the patient conditions. The system was tested during a titration procedure performed at the hospital with the ventilator controlled remotely by a physician. The results of this pilot trial showed that with this system it was possible to titrate accurately patient ventilation. Given its simplicity and low-cost, this system could provide an effective way to remotely titrate home mechanical ventilation and to periodically verify its appropriateness for the actual conditions of the patients.