title: Changing patterns in long-term noninvasive ventilation: a 7-year prospective study in the Geneva Lake area.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Prospective descriptive study.
  
  
  METHODS
  Two university hospitals and a pulmonary rehabilitation center.
  
  
  METHODS
  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.
  
  
  METHODS
  Annual, elective, standardized medical evaluations.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Pulmonary Division, Geneva University Hospital, Geneva, Switzerland. janssens@iprolink.ch
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Janssens
authors.forename: Sophie
authors.initials: S
authors.lastname: Derivaz
authors.forename: Eric
authors.initials: E
authors.lastname: Breitenstein
authors.forename: Benoît
authors.initials: B
authors.lastname: De Muralt
authors.forename: Jean-William
authors.initials: JW
authors.lastname: Fitting
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Chevrolet
authors.forename: Thierry
authors.initials: T
authors.lastname: Rochat
mesh_terms: D000368:Aged; D004867:Equipment Design; D006305:Health Status Indicators; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000295:instrumentation / Q000379:methods; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy*; D013557:Switzerland; D013997:Time Factors; D016312:Treatment Refusal