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Respir Med. 2008 Nov;102(11):1528-35. doi: 10.1016/j.rmed.2008.07.019. Epub 2008 Sep 7.

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

Author information

1
Sleep and Ventilation Unit, Academic and Clinical Department of Sleep and Breathing, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. m.chatwin@rbht.nhs.uk

Abstract

BACKGROUND:

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.

PMID:
18774702
DOI:
10.1016/j.rmed.2008.07.019
[Indexed for MEDLINE]
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