Randomised trial of inpatient versus outpatient initiation of home mechanical ventilation in patients with nocturnal hypoventilation

SummaryBackgroundLong-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.MethodsTwenty-eight stable neuromuscular and chest wall disease patients with nocturnal hypoventilation (transcutaneous carbon dioxide (TcCO2 >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.ResultsImprovements in nocturnal arterial oxygen saturation (SaO2) and daytime PaO2 were equivalent in both groups. Peak nocturnal TcCO2, improved in both groups; % time TcCO2 >6.5 kPa fell in the inpatient group and daytime PaCO2 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.ConclusionOutpatient initiation of HMV is feasible with equivalent outcome in the outpatient and the inpatient groups.