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

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 (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. Results: Improvements in nocturnal arterial oxygen saturation (SaO(2)) 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. Conclusion: Outpatient initiation of HMV is feasible with equivalent outcome in the outpatient and the inpatient groups. (C) 2008 Elsevier Ltd. All rights reserved.