Long-term community non-invasive ventilation

Abstract

Background: Community non-invasive ventilation (NIV) is increasingly used to treat chronic type 2 respiratory failure. Minimal information is published regarding patient acceptability or benefit. Records at our institution have information gaps. Aims: To survey patients on chronic NIV - collecting demographics, ventilator usage, health-related quality of life, adequacy of service provision and compare with clinical best practice. Methods: Audit tool developed and results analysed using descriptive statistics. Results: Of 73 patients identified, 45 (62%, mean age 55 years) completed the study. Obesity hypoventilation (37%) and overlap syndrome (22%) were the commonest indications. Reported compliance was high (96% using nocturnal NIV, mean 7.2 h) with 75% on treatment ≥2 years. Most patients lived at home (77%) and although one-third received home care, one-half were working. Nearly all (98%) report positive responses, including improved sleep and energy (83%), breathing (42%), driving or work (18%). Most (62%) have not been in hospital in the last 12 months. Negative aspects included practical issues with machine or mask, loss of intimacy and gaps in patient follow up. The provision of practical information, access to well-informed staff and the establishment of support networks were suggestions for service improvement. Conclusion: NIV provides a range of symptomatic benefits and maintains patients in the community with a reasonably good quality of life. To ensure a high level of care and patient satisfaction, several service areas warranting further development were identified. Our results should help promote this highly effective therapy and aid the development of Australasian NIV service guidelines. © 2010 The Authors. Internal Medicine Journal © 2010 Royal Australasian College of Physicians.