title: Randomised trial of inpatient versus outpatient initiation of home mechanical ventilation in patients with nocturnal hypoventilation.
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.
  
  
  CONCLUSIONS
  Outpatient initiation of HMV is feasible with equivalent outcome in the outpatient and the inpatient groups.
authors.affiliation: 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
authors.forename: Michelle
authors.initials: M
authors.lastname: Chatwin
authors.forename: Annabel H
authors.initials: AH
authors.lastname: Nickol
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Morrell
authors.forename: Michael I
authors.initials: MI
authors.lastname: Polkey
authors.forename: Anita K
authors.initials: AK
authors.lastname: Simonds
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001784:Blood Gas Analysis; D002648:Child; D005260:Female; D018575:Home Care Services, Hospital-Based / Q000458:organization & administration*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007040:Hypoventilation / Q000097:blood / Q000523:psychology / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000150:complications*; D011788:Quality of Life / Q000523:psychology*; D012121:Respiration, Artificial / Q000379:methods* / Q000523:psychology; D012891:Sleep Apnea Syndromes / Q000097:blood / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires; D014797:Vital Capacity / Q000502:physiology; D055815:Young Adult