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Abstract
Background HMV/domiciliary non-invasive ventilation (NIV) is being increasingly used to treat chronic ventilatory failure, particularly due to obesity and neuromuscular conditions. In patients attending an acute hospital, most domiciliary NIVs are set up at the end of an acute episode of admission with hypercapnic acidotic respiratory failure but over time, as more at-risk patients come under surveillance for respiratory failure, we hypothesised that a unit supervising domiciliary NIV/HMV 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 three 12-month periods: Apr 2005-Mar 2006 (period 1), Apr 2011-Mar 2012 (period 2) and Apr 2012-Mar 2013 (period 3) 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 260 patients with over 392 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; to 64 set- ups in period 3. The elective domiciliary NIV set-up rate increased from 7/19 (36.8%) to 19/39 (48.7%) to 30/64 (46.9%) for periods 1, 2 and 3 respectively [Figure 1].
Discussion We have previously shown that the elective set-up rate for new HMV has gone up in our unit. In this survey we have shown that this increase in 'elective set-up rate' is associated with a consistent increase in volume of HMV set-ups. This is most likely to be due to an increased number of people at risk of respiratory failure coming under the unit's surveillance. HMV is well known to improve quality of life and reduce unscheduled care utilisation when started at the appropriate timepoint in chronic ventilatory failure through surveillance. Comparison of data between centres supervising domiciliary NIV/HMV, e.g 'elective set-up rates', is warranted in this rapidly evolving field.
References
Agarwal S et al. Thorax 2012;67:A163. (doi:10.1136/thoraxjnl-2013-204457.327
HMV set-ups: Elective vs Acute.