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

Respir Med. 2008 Nov;102(11):1528-35. doi: 10.1016/j.rmed.2008.07.019. Epub 2008 Sep 7.


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.

Conclusion: Outpatient initiation of HMV is feasible with equivalent outcome in the outpatient and the inpatient groups.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Gas Analysis
  • Child
  • Female
  • Home Care Services, Hospital-Based / organization & administration*
  • Hospitalization / statistics & numerical data
  • Humans
  • Hypoventilation / blood
  • Hypoventilation / psychology
  • Hypoventilation / therapy*
  • Length of Stay
  • Male
  • Middle Aged
  • Neuromuscular Diseases / complications*
  • Quality of Life / psychology*
  • Respiration, Artificial / methods*
  • Respiration, Artificial / psychology
  • Sleep Apnea Syndromes / blood
  • Sleep Apnea Syndromes / psychology
  • Sleep Apnea Syndromes / therapy*
  • Surveys and Questionnaires
  • Vital Capacity / physiology
  • Young Adult