Adaptation and follow-up to noninvasive home mechanical ventilation: ambulatory versus hospital.
OBJECTIVE
Noninvasive home mechanical ventilation (HMV) has been shown to be beneficial for certain forms of respiratory failure, improving symptoms and quality of life. Adaptation and follow-up are usually conducted within the hospital framework. Our objective was to verify whether the same results could be obtained in the patient's home by the Home Hospitalization Unit.


METHODS
This was a prospective study of patients with stable restrictive ventilatory disorders, who met the criteria to receive HMV. They underwent hospital adaptation (group 1) or ambulatory adaptation (group 2) based on geographical area. The following tests were performed throughout the follow-up: Borg scale, respiratory function, arterial blood gases, nocturnal pulse oximetry, a health survey questionnaire (SF-36), and initially, the Barthel index. Adaptation and follow-up were performed identically in both groups in accordance with the adaptation and follow-up protocol of our hospital. Independent and intergroup comparisons were made for both groups.


RESULTS
Forty-two patients (21 at hospital and 21 at home) were included. No initial differences were found between the two groups. Improvements were noted on the Borg scale and for nocturnal pulse oximetry within the groups, with no differences between them. No improvement in pulmonary function was observed in either group. Arterial blood gases improved in both groups, but the ambulatory group recorded significantly higher values (PO(2), P=0.033; PCO(2), P=0.020). Most domains of the SF-36 questionnaire improved in both groups, although some intergroup differences were noted.


CONCLUSIONS
HMV improved arterial blood gases and quality of life in patients with restrictive ventilatory disorders. Arterial blood gases were better in the ambulatory group and the quality of life was similar in both groups.
Doménech-Clar
Rosalía
R
Unidad de Hospitalización a Domicilio, Hospital Universitario La Fe, Avenida Campanar 21, Valencia 46009, Spain. rosaliadom@ono.com
Nauffal-Manssur
Dolores
D
Compte-Torrero
Luís
L
Rosales-Almazán
Ma Dolores
MD
Martínez-Pérez
Encarna
E
Soriano-Melchor
Elisa
E
D003695:Delivery of Health Care / Q000458:organization & administration; D005260:Female; D005500:Follow-Up Studies; D018575:Home Care Services, Hospital-Based; D006801:Humans; D008297:Male; D008875:Middle Aged; D010092:Oximetry / Q000379:methods; D010102:Oxygen Inhalation Therapy / Q000379:methods* / Q000523:psychology; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life / Q000523:psychology; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*