Successful home noninvasive ventilation initiation rarely happens in real life: study

It is rare to achieve successful home noninvasive ventilation (NIV) in real life, reports a recent study. To improve patient-centred outcomes, health-related quality of life (HRQOL) and NIV tolerance must then be assessed.

“When home NIV is initiated, [the following] goals need to be achieved: a daily use >4 h/day, an improvement in gas exchange, HRQOL, and sleep quality without side effects,” the researchers said.

A monocentric cohort study was conducted, including patients electively established on home NIV over 2 years. The researchers evaluated HRQOL at baseline and follow-up using the Severe Respiratory Insufficiency questionnaire.

Adequate initiation was defined as the achievement of at least three of the goals, while successful initiation was defined as the achievement of all goals.

Overall, 250 patients were recruited at baseline. NIV was initiated for the following conditions: obesity hypoventilation syndrome (n=95; 38 percent), neuromuscular disease (n=70; 28 percent), chronic obstructive pulmonary disease (n=66; 26 percent), and chest wall disease (n=19; 8 percent).

Measures of all goals were available in more than half of the patients (n=141; 56 percent). NIV initiation was adequate for 96 patients (68 percent) and successful for 12 (9 percent).

Multivariate analysis revealed that a tidal volume ≥7.8 ml/kg of ideal body weight correlated with a greater likelihood of adequate NIV initiation (hazard ratio, 5.765, 95 percent confidence interval, 1.824–18.223; p=0.006).

Notably, improvement in daytime partial arterial carbon dioxide pressure (PaCO₂) did not improve HRQOL or sleep quality. Severe to very severe NIV-related side effects were observed in nearly half of the patients (n=114; 47 percent) and were associated with higher daytime PaCO₂ (6.35±1.08 vs 5.92±0.79 kPa; p<0.001).