What should ideal built-in software offer for monitoring home mechanical ventilation?

Monitoring of home mechanical ventilation (HMV) - including noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) - as well as continuous positive airway pressure (CPAP) is essential to ensure effective ventilation, optimize adherence, and improve patient outcomes in both pediatric and adult patients. Analysis of data derived from the built-in software of HMV and CPAP devices constitute a key component of routine monitoring. These data provide valuable information on treatment adherence, unintentional leaks, residual respiratory events, and patient-ventilator synchrony. In many clinical situations, these data may be sufficient to guide ventilator adjustments without full in-lab poly(somno)graphy. Although current built-in software offers multiple monitoring features, their availability and implementation vary widely across manufacturers. Limitations include incomplete access to settings and alarms, inconsistent leak and inspiratory time statistics, limited waveform visualization, and insufficient tools for scoring respiratory events and patient-ventilator asynchronies. Additional features-such as customizable adherence thresholds, dual cursors for time measurements, deselection of specific periods or events, and integration of physiologic signals like transcutaneous carbon dioxide pressure (PtcCO2) or thoraco-abdominal movements-could enhance monitoring. Standardizing and expanding built-in software capabilities would improve the precision of HMV and CPAP monitoring, facilitate individualized ventilator adjustments, and bring software analysis closer to poly(somno)graphy-level assessment. These enhancements have the potential to optimize patient-ventilator synchrony and overall treatment quality.