DIGIVENT – Digital, individualized support system for the ambulatory check of indication, initiation and control of non-invasive ventilation in COPD patients

Introduction: Today, initiation and control of non-invasive ventilation (NIV) remains resource intensive even in an ambulatory setting and demands a highly specialized medical team. Digital algorithms might support decisions in an ambulatory setting, making the process of NIV initiation and control accessible for less specialized staff. The aim of the current study was to establish and implement digital algorithms for patients with chronic hypercapnic respiratory failure due to COPD by a predefined process for starting and controlling NIV with the help of experienced respiratory physicians by creating a detailed descriptions of the current clinical practice.

Methods: The DIGIVENT project establishes and implements such algorithms for patients with chronic hypercapnic respiratory failure due to COPD. Hereby, experienced respiratory physicians from different clinics created detailed descriptions of the current clinical practice in order with the current national guideline. These descriptions led to clear workflows enabling us to use Business Process Model and Notation (BPMN) as a tool to formalize these workflows. The BPMN data made a digital implementation of these workflows possible, reflecting clinical decision making in digital algorithms. A user-friendly interface allowed us to test the algorithms with virtual patient cases to assess their safety and efficacy.

Results: The predefined test procedure for the DIGIVENT system included 5 virtual patient cases and a list of safety rules the system is expected to abide by. In all patient cases, the indication for NIV was correctly stated. Initiation and control of NIV were performed in safe and effective ways as judged by two respiratory physicians. All specified safety rules were successfully tested. Also, the user interface of the system allowed the respiratory physicians to interact with the system without external aid.

Conclusion: We report the first implementation and successful virtual test of a digital algorithm for the initiation and control of NIV. Still, only clinical studies will reveal the pitfalls and potentials of the system which follows as the next step in the DIGIVENT project.