Changing patterns in long-term noninvasive ventilation: a 7-year prospective study in the Geneva Lake area.

STUDY

OBJECTIVES

To describe a 7-year follow-up (1992 to 2000) of patients who were treated by home nasal positive-pressure ventilation (NPPV) for chronic hypercapnic respiratory failure.

DESIGN

Prospective descriptive study.

SETTING

Two university hospitals and a pulmonary rehabilitation center.

PATIENTS: Two hundred eleven patients with obstructive pulmonary disorders (58 patients) or restrictive pulmonary disorders (post-tuberculosis, 23 patients; neuromuscular diseases [NM], 28 patients; post-poliomyelitis syndrome, 12 patients; kyphoscoliosis [KYPH], 19 patients; obesity-hypoventilation syndrome [OHS], 71 patients) who were treated by long-term NPPV.

INTERVENTION: Annual, elective, standardized medical evaluations.

MEASUREMENTS: Pulmonary function tests, arterial blood gas levels, health status, compliance, survival and probability of pursuing NPPV, and hospitalization rates.

RESULTS

Patients with OHS, NM, and KYPH had the highest probability of pursuing NPPV, while patients with COPD had the lowest values. Overall, the compliance rate was high (noncompliance rate, 15%). As of 1994, COPD and OHS became the most frequent indications for NPPV, increasing regularly, while other indications remained stable. The use of pressure-cycled ventilators progressively replaced that of volume-cycled ventilators in most indications. Hospitalization rates decreased in all groups after initiating NPPV, when compared with the year before NPPV, for up to 2 years in COPD patients, and 5 years in non-COPD patients.

CONCLUSION

Major changes in patient selection for NPPV occurred during the study period with a marked increase in COPD and OHS. The shift toward less expensive pressure-cycled ventilators and the decrease in hospitalizations after initiating NPPV have had positive impacts on the cost-effectiveness of NPPV in patients with chronic respiratory failure.