Moving from Inpatient to Outpatient or Home Initiation of Non-Invasive Home Mechanical Ventilation
Abstract
:1. Introduction
2. Outpatient Initiation of NIV
2.1. Feasibility and Safety of Outpatient Initiation of NIV
2.2. Effectiveness of Outpatient Initiation of NIV
2.3. Cost Savings of Outpatient Initiation of NIV
3. Home Initiation of NIV
3.1. Feasibility and Safety of Home Initiation of NIV
3.2. Effectiveness of Home Initiation of NIV
3.3. Cost Savings of Home Initiation of NIV
4. Discussion
- (1)
- Why initiate in the outpatient or home setting?
- (2)
- When to consider outpatient or home initiation?
- (3)
- Where to initiate: hospital, outpatient clinic, or home?
- (4)
- Who are suitable candidates for outpatient or home initiation?
- (5)
- How is outpatient of home initiation of HMV performed?
5. Future Directions and Outlook
6. Limitations of This Study
7. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Study | Country | Cases No. | Design | Diseases | Sessions Needed | Cost Reduction | Primary Outcome |
---|---|---|---|---|---|---|---|
Luján et al., 2007 [5] | Spain | 16 | Prospective uncontrolled | NMD, COPD, OHS, RLD | 5.5 ± 1.3 | −53% | Effectiveness |
Chatwin et al., 2008 [6] | UK | 28 | RCT | NMD, RLD | 1.2 ± 0.4 | Effectiveness | |
Pallero et al., 2014 [7] | Spain | 53 | RCT | NMD, OHS, RLD | 2.71 ± 0.99 | −44% | Effectiveness |
Sheers et al., 2014 [8] | Australia | 29 | Prospective uncontrolled | MND | 1 (0–5) days | Waiting time | |
Bertella et al., 2017 [9] | Italy | 50 | RCT | NMD | 4 ± 2 | Acceptance and adherence | |
Ribeiro et al., 2022 [10] | Portugal | 235 | Cross-sectional | COPD, NMD, OHS, RLD | Patient view | ||
Murphy et al., 2023 [11] | UK and France | 82 | RCT | OHS | 1 | +6% (NS) | Costs and HRQOL |
Study | Country | Cases No | Design | Diseases | Primary Outcome | Cost Reduction | Monitoring |
---|---|---|---|---|---|---|---|
Doménech-Clar et al., 2008 [14] | Spain | 42 | Prospective uncontrolled | NMD, OHS, RLD | Effectiveness Daytime ΔPaCO2 | Pulse oximetry Blood gases | |
Hazenberg et al., 2008 [15] | Netherlands | 77 | RCT | NMD, RLD | Effectiveness Daytime ΔPaCO2 | 81% | Tc Capnography Telemonitoring |
Van den Biggelaar et al., 2020 [16] | Netherlands | 96 | RCT | NMD, OHS, RLD | Effectiveness Daytime ΔPaCO2 | 68% | Tc Capnography Telemonitoring |
Duiverman et al., 2020 [17] | Netherlands | 67 | RCT | COPD | Effectiveness Daytime ΔPaCO2 | 56% | Tc Capnography Telemonitoring |
Volpato et al., 2022 [18] | Italy | 66 | RCT | MND | Effectiveness Daytime ΔPaCO2 | Pulse oximetry ETCO2 |
Advantages | Outpatient Initiation | Home Initiation |
---|---|---|
Feasible in all disease groups: NMD, RLD, COPD, OHS | +++ | +++ |
Fewer hospital beds needed | +++ | +++ |
Reduced waiting time to NIV initiation | +++ | +++ |
Potential for fewer acute admissions | +++ | +++ |
Similar acceptance as inpatient initiation | +++ | +++ |
Adverse effects similar to inpatient setup | +++ | +++ |
Effectiveness equal to inpatient initiation | +++ | +++ |
Adequate therapeutic compliance | +++ | +++ |
Potential for cost savings | ++ | +++ |
Reduced infection risk | ++ | +++ |
Adequate resources and availability of experienced and involved caregivers for personal needs | + | +++ |
Familiar and supportive environment for patients | + | +++ |
Possibility to fulfil family or job obligations | + | +++ |
Patient convenience | ++ | +++ |
Patient preference | ++ | +++ |
Disadvantages | Outpatient Initiation | Home Initiation |
Unsuitable for patients with unstable medical conditions, severe comorbidities, complex care needs, lack of motivation, cognitive impairment, anxiety of living far from hospital, etc. | ++ | +++ |
Implementation depends on local geography, infrastructure, and health system features | + | +++ |
Potential for complications, which may be difficult to manage | + | +++ |
Potential for higher healthcare utilization (phone calls, unscheduled hospital stays, outpatient clinic visits, and emergency home visits) | ++ | +++ |
Staff needs extensive knowledge and experience with initiation of NIV | ++ | +++ |
Need for change in staffing model | + | +++ |
Technical problems with (tele-)monitoring | + | +++ |
Investment in equipment needed | + | +++ |
Logistical challenges in arranging for delivery of equipment and training | + | +++ |
Potential for increased caregiver burden | + | +++ |
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Kampelmacher, M.J. Moving from Inpatient to Outpatient or Home Initiation of Non-Invasive Home Mechanical Ventilation. J. Clin. Med. 2023, 12, 2981. https://doi.org/10.3390/jcm12082981
Kampelmacher MJ. Moving from Inpatient to Outpatient or Home Initiation of Non-Invasive Home Mechanical Ventilation. Journal of Clinical Medicine. 2023; 12(8):2981. https://doi.org/10.3390/jcm12082981
Chicago/Turabian StyleKampelmacher, Mike J. 2023. "Moving from Inpatient to Outpatient or Home Initiation of Non-Invasive Home Mechanical Ventilation" Journal of Clinical Medicine 12, no. 8: 2981. https://doi.org/10.3390/jcm12082981