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Chest. 2003 Jan;123(1):67-79.

Changing patterns in long-term noninvasive ventilation: a 7-year prospective study in the Geneva Lake area.

Author information

1
Pulmonary Division, Geneva University Hospital, Geneva, Switzerland. janssens@iprolink.ch

Abstract

STUDY OBJECTIVES:

To describe a 7-year follow-up (1992 to 2000) of patients who were treated by home nasal positive-pressure ventilation (NPPV) for chronic hypercapnic respiratory failure.

DESIGN:

Prospective descriptive study.

SETTING:

Two university hospitals and a pulmonary rehabilitation center.

PATIENTS:

Two hundred eleven patients with obstructive pulmonary disorders (58 patients) or restrictive pulmonary disorders (post-tuberculosis, 23 patients; neuromuscular diseases [NM], 28 patients; post-poliomyelitis syndrome, 12 patients; kyphoscoliosis [KYPH], 19 patients; obesity-hypoventilation syndrome [OHS], 71 patients) who were treated by long-term NPPV.

INTERVENTION:

Annual, elective, standardized medical evaluations.

MEASUREMENTS:

Pulmonary function tests, arterial blood gas levels, health status, compliance, survival and probability of pursuing NPPV, and hospitalization rates.

RESULTS:

Patients with OHS, NM, and KYPH had the highest probability of pursuing NPPV, while patients with COPD had the lowest values. Overall, the compliance rate was high (noncompliance rate, 15%). As of 1994, COPD and OHS became the most frequent indications for NPPV, increasing regularly, while other indications remained stable. The use of pressure-cycled ventilators progressively replaced that of volume-cycled ventilators in most indications. Hospitalization rates decreased in all groups after initiating NPPV, when compared with the year before NPPV, for up to 2 years in COPD patients, and 5 years in non-COPD patients.

CONCLUSION:

Major changes in patient selection for NPPV occurred during the study period with a marked increase in COPD and OHS. The shift toward less expensive pressure-cycled ventilators and the decrease in hospitalizations after initiating NPPV have had positive impacts on the cost-effectiveness of NPPV in patients with chronic respiratory failure.

PMID:
12527605
DOI:
10.1378/chest.123.1.67
[Indexed for MEDLINE]

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