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Randomised trial of inpatient versus outpatient initiation of home mechanical ventilation in patients with nocturnal hypoventilation.

AbstractBACKGROUND:
Long-term home mechanical ventilation (HMV) is usually initiated in hospital. Admission to hospital has resource implications and may not be reimbursable in some healthcare systems.
METHODS:
Twenty-eight stable neuromuscular and chest wall disease patients with nocturnal hypoventilation (transcutaneous carbon dioxide (TcCO(2) >6.5 kPa), were randomised to start HMV either as an outpatient (n=14, age range 12-62 years) or inpatient (n=14, age range 14-73 years). We compared effects of HMV on nocturnal and diurnal arterial blood gas tensions, ventilator compliance, healthcare professional (HCP) contact time, and time in hospital.
RESULTS:
Improvements in nocturnal arterial oxygen saturation (SaO(2)) and daytime PaO(2) were equivalent in both groups. Peak nocturnal TcCO(2), improved in both groups; % time TcCO(2) >6.5 kPa fell in the inpatient group and daytime PaCO(2) decreased significantly (p<0.05) in the outpatient group. The mean (SD) inpatient stay was 3.8 (1.0) days, and the outpatient attendance sessions 1.2 (0.4). HCP contact time including telephone calls was: inpatient 177 (99) min; outpatient 188 (60) min (p=not significant); 2 month ventilator compliance was: inpatient 4.32 (7); outpatient 3.92 (8) (p=not significant) hours per night.
CONCLUSION:
Outpatient initiation of HMV is feasible with equivalent outcome in the outpatient and the inpatient groups.
AuthorsMichelle Chatwin, Annabel H Nickol, Mary J Morrell, Michael I Polkey, Anita K Simonds
JournalRespiratory medicine (Respir Med) Vol. 102 Issue 11 Pg. 1528-35 (Nov 2008) ISSN: 1532-3064 [Electronic] England
PMID18774702 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Topics
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Gas Analysis
  • Child
  • Female
  • Home Care Services, Hospital-Based (organization & administration)
  • Hospitalization (statistics & numerical data)
  • Humans
  • Hypoventilation (blood, psychology, therapy)
  • Length of Stay
  • Male
  • Middle Aged
  • Neuromuscular Diseases (complications)
  • Quality of Life (psychology)
  • Respiration, Artificial (methods, psychology)
  • Sleep Apnea Syndromes (blood, psychology, therapy)
  • Surveys and Questionnaires
  • Vital Capacity (physiology)
  • Young Adult

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