Introduction Domiciliary NIV is being increasingly used to treat chronic ventilatory failure, particularly due to obesity and neuromuscular conditions. In the course of evolution of an NIV unit within an acute hospital, most domiciliary NIVs are set up at the end of an acute episode of admission with hypercapnic acidotic respiratory failure to start with, but overtime, as more at-risk patients come under surveillance for respiratory failure, we hypothesized that a unit supervising domiciliary NIV/Home Mechanical Ventilation is expected to do more elective set-ups.
Methods Comparison of the volume of new domiciliary NIV set-ups and the elective NIV set-up rate over two 12-month periods: Apr 2005-Mar 2006 (period 1) and Apr 2011-Mar 2012 (period 2) in a dedicated 11-bedded ward-based NIV unit (established: Aug 2004) in a 1000-bedded central England teaching hospital trust, providing domiciliary NIV support to over 200 patients with over 350 under surveillance for respiratory failure.
Results The volume more than doubled from 19 new domiciliary NIV set-ups in period 1 to 39 new domiciliary NIV set-ups in period 2; the elective domiciliary NIV set-up rate increased from 7/19 (36.8%) to 19/39 (48.7%) between periods 1 and 2.
Discussion Over time, both the volume and the elective set-uprate for new domiciliary NIV have gone up. This probably indicates that a larger proportion of people at risk of respiratory failure treatable with NIV are coming under the unit’s surveillance and has clearly been associated with the expansion and maturation of the NIV service in our experience. The ‘elective domiciliary NIV set-up rate’ can therefore be tested as a metric for comparison of centres supervising domiciliary NIV/Home Mechanical Ventilation in this rapidly evolving field.
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