title: Initiation of home mechanical ventilation at home: a randomised controlled trial of efficacy, feasibility and costs.
abstract: BACKGROUND
  Home mechanical ventilation (HMV) in the Netherlands is normally initiated in hospital, but this is expensive and often a burden for the patient. In this randomised controlled study we investigated whether initiation of HMV at home in patients with chronic respiratory failure is non-inferior to an in hospital based setting.
  
  
  METHODS
  Seventy-seven patients were included, of which 38 patients started HMV at home. All patients were diagnosed with chronic respiratory failure due to a neuromuscular or thoracic cage disease. Primary outcome was the arterial carbon dioxide (PaCO2) while quality of life and costs were secondary outcomes. Telemonitoring was used in the home group to provide therapeutic information, for example; transcutaneous carbon dioxide, oxygen saturation and ventilator information, to the caregivers. Follow-up was six months.
  
  
  RESULTS
  PaCO2, improved by 0.72 (SE ± 0.16) kPa in the hospital group and by 0.91 (±0.20) in the home group, both improvements being significant and the latter clearly not inferior. There were also significant improvements in quality of life in both groups, again not being inferior with home treatment.
  
  
  CONCLUSIONS
  This study is the first to show that initiation of HMV at home in a selective group of patients with chronic respiratory failure is as effective for gas exchange and quality of life as hospital initiation. In addition we found that it is safe, technically feasible and that more than € 3000 per patient can be saved compared to our standard care.
authors: University of Groningen, University Medical Center Groningen, Department of Pulmonology and Tuberculosis, Department of Home Mechanical Ventilation, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, GRIAC Research Institute, The Netherlands. Electronic address: a.hazenberg@umcg.nl.
authors: A
authors: A
authors: Hazenberg
authors: University of Groningen, University Medical Center Groningen, Department of Pulmonology and Tuberculosis, Department of Home Mechanical Ventilation, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, GRIAC Research Institute, The Netherlands.
authors: H A M
authors: HA
authors: Kerstjens
authors: TNO - The Netherlands Organization for Applied Scientific Research, The Netherlands.
authors: S C L
authors: SC
authors: Prins
authors: University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands.
authors: K M
authors: KM
authors: Vermeulen
authors: University of Groningen, University Medical Center Groningen, Department of Pulmonology and Tuberculosis, Department of Home Mechanical Ventilation, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, GRIAC Research Institute, The Netherlands.
authors: P J
authors: PJ
authors: Wijkstra
mesh_terms: D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000097:blood; D002908:Chronic Disease; D005240:Feasibility Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D018575:Home Care Services, Hospital-Based / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D009426:Netherlands; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011446:Prospective Studies; D011788:Quality of Life; D012121:Respiration, Artificial / Q000191:economics / Q000379:methods*; D012131:Respiratory Insufficiency / Q000097:blood / Q000191:economics / Q000628:therapy*; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen
keywords: Carbon dioxide; Chronic ventilatory support; Home mechanical ventilation; Non-invasive ventilation; Telemonitoring