TY - JOUR T1 - Precision medicine is coming to town: personalising home ventilatory equipment in COPD patients with chronic hypercapnic respiratory failure JF - European Respiratory Review JO - EUROPEAN RESPIRATORY REVIEW DO - 10.1183/16000617.0043-2019 VL - 28 IS - 154 SP - 190043 AU - Jesus Gonzalez-Bermejo AU - Stefano Nava AU - Claudio Rabec AU - Maria Laura Vega Y1 - 2019/12/31 UR - http://err.ersjournals.com/content/28/154/190043.abstract N2 - Discharging a chronic critically ill patient is a risky procedure if the clinician does not have full control of his prescription. This is even more important when applying a machine to replace a failing organ, as is the case for home ventilation. Even if modern home ventilators fulfil quality and safety criteria and, ‘on paper’, ventilators and masks look very similar, performance and scenarios of applicability are not always equivalent. In the case of ventilators, the type of circuit, accessories provided and available modes vary between devices. Bench studies comparing ventilators have shown large differences in triggering, rise time, pressurisation capacities, maximal flow provided, cycling and level of authorised expiratory positive airway pressure. Automated algorithms to deal with leaks also vary and have not been sufficiently evaluated. In the case of interfaces, the choice of mask requires careful evaluation of the underlying disease and of the type of ventilator and circuit, which could have a potentially major impact on patient compliance and clinical effectiveness. This could explain different results in the same clinical situation. The choice of ventilator and type of mask represents a medical prescription and should be respected by the provider and not subject to financial constraints.Discharging a patient under mechanical ventilation is a risky procedure if the clinician does not have control of the prescription. In this review we assess the problems that a clinician may encounter when the payer is the main driver of the choice. http://bit.ly/2L33mS7 ER -