Introduction and objectives Home Mechanical Ventilation (HMV) for patients with chronic ventilatory failure (CVF) often requires hospital admission for initiation of treatment. There are limited data evaluating the efficacy, efficiency and safety of initiating HMV in the domiciliary setting. Our centre has undertaken over 200 ‘home set-ups’ and we have evaluated outcomes in these patients.
Methods Patients with CVF who had HMV initiated in the domiciliary or outpatient setting were identified from our hospital database and data were retrospectively collected from their hospital records.
Results 214 patients with CVF were set-up at home between 2004 to 2013. Notes were available for 193 (90%) patients, mean (SD) age 59 (14) years, 63% male. The majority of patients had Motor Neuron Disease (MND)(30%) or obesity related respiratory failure (23%). Baseline lung function and arterial blood gas parameters are shown in Table 1.
178 (92%) patients had HMV initiated in their home; 15 attended the outpatient clinic for set-up. Three patients subsequently required hospital admission to support adaptation to HMV.
Following initiation, 135 (70%) patients were assessed as compliant with HMV, defined as >4 h self-reported use each night. Patients with MND had the lowest compliance rate with only 30 (52%) achieving this usage. If those with MND are excluded, overall compliance was 77% which is similar to our inpatient initiated HMV compliance rate of 83% (n = 224) and to case series reported by other centres.
Patients with few symptoms of nocturnal hypoventilation had a lower compliance rate (55%) than more symptomatic patients (71%).
In patients who were compliant with HMV, mean (SD) time until >4 h use per night was 27 (60) days, but 33 (17%) patients achieved this usage after the first night. Those who became compliant with HMV had a mean of 2.9 (3.2) home visits and 1.4 (1.8) phone calls each.
Conclusion Establishing HMV in the domiciliary and outpatient setting can be effectively and safely achieved, even in patients with marked nocturnal hypoventilation. Apart from patients with MND or those who are minimally symptomatic, ‘home set-up’ of HMV does not appear to affect compliance significantly.