Ventilation: Enhancing communication to deliver health outcomes

My concern : find a way to give a voice to patient on a ventilator

Arnaud: For 33 years, I've closely supported patients battling chronic respiratory failures. Some of the most heartbreaking moments were with people who could no longer speak, their voices stolen by their illness. Imagine their frustration, their fear, unable to express how they felt about the treatment that was meant to help them breathe easier. Those patients are dependent on a machine to breathe, and yet they can't tell you if it feels right, if it's too much, too little... You do your best to understand them, but sometimes I felt so helpless. That frustration fueled me. I had to find a way to give them a voice. My role is really to represent the reality of a patient on a ventilator, what is actually happening on the ground. It is crucial for Air Liquide Healthcare to understand who patients and caregivers really are. Figuring out how to adjust settings, as a result of the balance between therapy efficacy and patient tolerance. I really wanted to understand, patient by patient, the right way to ventilate them properly. The early discussions with doctors were also essential and the main key lesson is the absolute necessity of a personalized approach—ventilation is not a “one size fits all” solution.

Finding the right balance between comfort and efficacy

What is mechanical ventilation?

Arnaud: Non-invasive ventilation (NIV) is a respiratory support method that uses a mask to deliver air from a ventilator to a patient's lungs, avoiding the need for an invasive breathing tube. It's a widely used treatment for chronic respiratory failure, particularly in the home setting. However, successfully integrating NIV into a patient's life hinges on their comfort and acceptance of the therapy. For a patient receiving mechanical ventilation, a key challenge is communicating their subjective feelings about the therapy. What is the patient's experience—whether the pressure feels "too much" or "not enough"—is subjective and vital for optimal settings. Without an objective way to share this feedback, physicians, nurses or technicians can struggle to make the precise adjustments needed to improve tolerance and, as a result, therapy adherence.

As caregivers, it is always a challenge to find the right balance between what the patients can tolerate and what we want in terms of treatment efficiency.

In other words, the healthcare professionals seek both:

• acceptable settings for the patient which impact the tolerance of the ventilation device
• expected therapeutic outcomes which linked to efficacy

Mechanical ventilation can be challenging for patients and healthcare professionals alike

Arnaud: The best way to help both patients and caregivers was to facilitate information sharing among them, the communication being difficult, sometimes impossible. The first step was to find a common language and a frame of questions and answers to define the best settings. An experts group has been created to define the 5 main settings¹ for acting on tolerance to spontaneous ventilation. They are:

1. inspiratory pressure
2. expiratory pressure
3. inspiration time
4. rise time
5. trigger sensitivity

How patient communication is a game-changer in ventilation

The 'Ventilation Experience Tool’

Arnaud: We worked closely with the Aalborg hospital team in Denmark. Thanks to them, Air Liquide Healthcare has improved the ‘Ventilation Experience tool’ prototype. Patients need to know that you understand how they feel—the fear, the anxiety—but also that you can solve their technical problems and really listen to them, so you can then find the most appropriate solutions. Ventilation adjustment is not just technical or medical. Every ventilated patient, at some point, has difficulty communicating their needs during these critical adjustments. The ‘Ventilation Experience Tool” bridges that gap. It opens up a whole new level of communication and trust between the patient and the care team. If we can empower patients to become more involved and restore a sense of control, that's a win in my book!

Connecting quickly with the patient

Arnaud: The collaboration with caregivers allowed me to fine-tune the prototype. Their practices were integrated in the tool with the objective that it could be used both at hospital and at home during the regular visits. In detail, we invented a decision-support instrument that leverages patient-reported outcomes (PROMs). The operator facilitates feedback by asking simple and understandable questions for the patient. The patient subjectively rates his/her comfort level by adjusting a cursor in a scale from 1 to 7 to reflect their preferred feeling or tolerance on each setting. This input instantly provides the operator with suggested setting adjustments tailored to the patient’s feedback. Our ‘Ventilation Experience Tool’ simplifies a complex process: patients use a sliding bar to rate their comfort level, and this feedback provides the healthcare professionals with suggested ventilator adjustments. It's a game-changer for patients who struggle to articulate their feelings, including those who are no longer able to speak. This innovation empowers patients to actively participate in their care, fostering a powerful connection with their caregivers and restoring a sense of control. Our tool could be used at 3 and 12 months follow-up.

In facts: a  recognized innovation

The ‘Ventilation Experience Tool’ has already proven to be very promising. According to a survey² conducted in several countries among 57 healthcare professionals in France, Spain, Korea, and Germany, the ‘Ventilation Experience Tool’ achieved a satisfaction score of 4.1 out of 5. The results highlight that the tool contributes significantly to:

• Involving patients in their therapy
• Improving communication between patients and healthcare providers and understanding the patient experience
• Saving healthcare professionals time and simplifying their practice

Summary: the future of Value-based Healthcare in non-invasive ventilation (NIV)

Air Liquide Healthcare's 'Ventilation Experience Tool’ is a clear example of Value-based Healthcare in action. By focusing on improving patient comfort and communication, the tool aims to increase therapy adherence and clinical outcomes and thus improve the entire care process. This is a modest but important step toward patients and healthcare professionals working together to achieve better health outcomes.

To remember

• The ‘Ventilation Experience Tool’ is a simple visual tool to ease the communication between patient and healthcare professionals with the aim to objectively share patient’s comfort and improve device settings.

• By developing tools that put patients at the center of their treatment, Air Liquide Healthcare aims to improve compliance and health outcomes that matter to patients.The ‘Ventilation Experience Tool’ could be used at hospital and during visits at home to improve the initiation process but also the support follow-up.

• Surveys and testimonials show that the ‘Ventilation Experience Tool’ is appreciated by patients and healthcare professionals.