Randomised trial of inpatient versus outpatient initiation of home mechanical ventilation in patients with nocturnal hypoventilation.
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.
Chatwin
Michelle
M
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
Nickol
Annabel H
AH
Morrell
Mary J
MJ
Polkey
Michael I
MI
Simonds
Anita K
AK
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