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Home initiation of chronic non-invasive ventilation in COPD patients with chronic hypercapnic respiratory failure: a randomised controlled trial

Thorax, 2020-03, Vol.75 (3), p.244-252 [Peer Reviewed Journal]

Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. ;2020 Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. 2020 ;ISSN: 0040-6376 ;EISSN: 1468-3296 ;DOI: 10.1136/thoraxjnl-2019-213303 ;PMID: 31484786

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  • Title:
    Home initiation of chronic non-invasive ventilation in COPD patients with chronic hypercapnic respiratory failure: a randomised controlled trial
  • Author: Duiverman, Marieke L ; Vonk, Judith M ; Bladder, Gerrie ; van Melle, Joost P ; Nieuwenhuis, Jellie ; Hazenberg, Anda ; Kerstjens, Huib A M ; van Boven, Job F M ; Wijkstra, Peter J
  • Subjects: Angina pectoris ; Carbon dioxide ; Chronic obstructive pulmonary disease ; Cost control ; Hospitals ; Non-Invasive Ventilation ; Outpatient care facilities ; Oxygen therapy ; Patients ; Questionnaires ; Respiratory failure ; Studies ; Telemedicine ; Ventilators
  • Is Part Of: Thorax, 2020-03, Vol.75 (3), p.244-252
  • Description: IntroductionChronic non-invasive ventilation (NIV) has become evidence-based care for stable hypercapnic COPD patients. While the number of patients increases, home initiation of NIV would greatly alleviate the healthcare burden. We hypothesise that home initiation of NIV with the use of telemedicine in stable hypercapnic COPD is non-inferior to in-hospital NIV initiation.MethodsSixty-seven stable hypercapnic COPD patients were randomised to initiation of NIV in the hospital or at home using telemedicine. Primary outcome was daytime arterial carbon dioxide pressure (PaCO2) reduction after 6 months NIV, with a non-inferiority margin of 0.4 kPa. Secondary outcomes were health-related quality of life (HRQoL) and costs.ResultsHome NIV initiation was non-inferior to in-hospital initiation (adjusted mean difference in PaCO2 change home vs in-hospital: 0.04 kPa (95% CI −0.31 to 0.38 kPa), with both groups showing a PaCO2 reduction at 6 months compared with baseline (home: from 7.3±0.9 to 6.4±0.8 kPa (p<0.001) and in-hospital: from 7.4±1.0 to 6.4±0.6 kPa (p<0.001)). In both groups, HRQoL improved without a difference in change between groups (Clinical COPD Questionnaire total score-adjusted mean difference 0.0 (95% CI −0.4 to 0.5)). Furthermore, home NIV initiation was significantly cheaper (home: median €3768 (IQR €3546–€4163) vs in-hospital: median €8537 (IQR €7540–€9175); p<0.001).DiscussionThis is the first study showing that home initiation of chronic NIV in stable hypercapnic COPD patients, with the use of telemedicine, is non-inferior to in-hospital initiation, safe and reduces costs by over 50%.Trial registration number NCT02652559.
  • Publisher: England: BMJ Publishing Group LTD
  • Language: English
  • Identifier: ISSN: 0040-6376
    EISSN: 1468-3296
    DOI: 10.1136/thoraxjnl-2019-213303
    PMID: 31484786
  • Source: BMJ Open Access Journals
    Alma/SFX Local Collection
    ProQuest Central
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