Non-invasive home mechanical ventilation:: Effectiveness and efficiency of an outpatient initiation protocol compared with the standard in-hospital model

Objective: To compare the effectiveness and efficiency of an initiation protocol for non-invasive- home mechanical ventilation (NIHMV) carried out at a pulmonary outpatient clinic with the standard in-hospital model. Methods: Prospective, observational study. Population: 16 patients divided into two groups: (A) outpatient protocol (n = 9); and (B) standard in-hospitat initiation with an elective admission (n = 7). Instrumentation: at baseline condition and treatment starting, arterial blood gases and nocturnal pulse-oximetry were performed. At the end of follow-up, arterial blood gases and patient compliance (ventilator's built-in counter) was determined. Efficiency was evaluated by calculating cost savings per ventilated patient for the financier and accumulated days of hospitalization saved. Results: No differences in baseline conditions were observed. Ventilation was effective in the two groups: a significant decrease in PaCO2 and an increase in mean nocturnal oxygen saturation were observed after initiating ventilation. (Group A: PaCo2:42.9 +/- 1.5; SPO2:91.9 +/- 1.9; Group B: PaCO2:44.3 +/- 6; SPO2:91.9 +/- 2.7). At three months the effectiveness of ventilation and the number of hours of ventilation was equivalent in all groups. The new model cut costs for the health care financier by 50%. The outpatient sessions saved 63 days of hospitalization. Conclusions: (1) Outpatient initiation is an effective and efficient alternative to the traditional in-hospital method for NIHMV. (2) The outpatient protocol represents a substantial saving for the financier. (c) 2006 Elsevier Ltd. All rights reserved.