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Models of care that minimise the use of acute hospital beds have become increasingly important during the COVID-19 pandemic, not only to optimise capacity for acute care, but also to minimise infection transmission risks and meet the needs of patients who avoid care due to concerns regarding attending healthcare facilities. Treatment with non-invasive ventilation (NIV) improves symptoms and reduces mortality and hospitalisations in those with chronic ventilatory failure due to neuromuscular disease, COPD and obesity hypoventilation syndrome (OHS). The practices for initiation of NIV vary widely, reflecting limited research on which to base model of care decisions, local healthcare system idiosyncrasies, funding models and historical practice. Some services initiate treatment in acute hospitals, with admissions lasting from a day to a week, while for others initiation is undertaken at home. An important contribution to designing models for NIV initiation, Murphy and colleagues1 demonstrate that initiating ventilation using auto-titrating NIV at home combined with oximetry monitoring was clinically effective and safe in comparison with in-hospital titration of fixed pressure NIV in patients with stable OHS.1 Interestingly, the healthcare costs over 3 months were similar in both models, with higher set-up costs for the inpatient model, but higher …
Contributors MEH drafted the manuscript. AR provided critical review. Both authors approved the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests MEH has received equipment support for research through their institution for research from Philips Respironics and funding from ResMed Foundation for investigator-initiated research.
Provenance and peer review Commissioned; externally peer reviewed.