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Keywords:

  • non-invasive ventilation;
  • respiratory failure and compliance;
  • sleep disorder;
  • ventilation

Abstract

  1. Top of page
  2. Abstract
  3. ACKNOWLEDGEMENT
  4. REFERENCES

Home non-invasive ventilation (NIV) is being increasingly employed to treat chronic hypercapnic respiratory failure. However, there is little data on compliance with home NIV. Sixty-five patients, aged 72.6 ± 9.4 years, who were using home NIV were administered a questionnaire on symptomatology and adverse effects associated with home NIV. Mean daily use of home NIV was 7.3 ± 2.9 h/day, and the median percentage of days on which home NIV was used for ≥4 h/day was 96.7%.

Despite the widespread use of home non-invasive ventilation (NIV) to treat chronic hypercapnic respiratory failure, compliance with home NIV among patients and the factors affecting compliance have seldom been systematically studied across different diseases. Compliance with NIV of 10.5 ± 2 h/day was reported for six patients,1 and a self-report of 96% use of nocturnal NIV (mean of 7.2 h/night) was recorded in another study.2 The disease-specific compliance with home NIV has been reported for patients with chronic obstructive pulmonary disease and those with amyotrophic lateral sclerosis.3–5

We performed a cross-sectional, observational study on patients using home NIV for chronic hypercapnic respiratory failure due to various causes. The machine-on time during the 180 days preceding the study visit was recorded on the time counters fitted to the NIV machines (Respironics and ResMed). Written consent to completing the questionnaire and for review of their case notes was obtained from the patients. The study was approved by the Research Ethics Committee of the Kowloon East Cluster Hospitals of the Hospital Authority.

One hundred eight patients using home NIV have been managed in our ventilator clinic. Fifteen patients were lost to follow up before the study commenced (1 April 2010 to 31 July 2010), 13 patients had died and 15 patients were excluded (1 was using another brand of home NIV machine, 1 had cognitive impairment and 13 used home NIV for less than 1 year). None of the patients stopped NIV during the study period because of compliance issues. Sixty-five patients completed the study; 39 patients (60%) were men, the mean age was 72.6 ± 9.4 years, and the NIV settings were inspiratory positive airway pressure/expiratory positive airway pressure = 15.9 ± 3/7.4 ± 2.9 cmH2O, spontaneous/timed mode with backup rate = 13.4 ± 2.1/min. The median duration of home NIV use was 2.5 years.

The mean daily use of home NIV was 7.3 ± 2.9 h/day (Fig. 1). The indications and mean NIV usage were as follows: Stage IV chronic obstructive pulmonary disease, 40%, 8.1 ± 3.2 h/day; chronic obstructive pulmonary disease/obstructive sleep apnoea, 32.3%, 6.7 ± 2.6 h/day; restrictive thoracic diseases, 10.8%, 7.8 ± 3.0 h/day; obesity hypoventilation syndrome, 7.7%, 6.5 ± 2.7 h/day; neuromuscular disorders, 3.1%, 3.1 ± 3.9 h/day; and mixed pathology, 6.1%, 7.3 ± 1.7 h/day. Fifty-one patients (78.5%) consistently used home NIV for ≥4 h/day on ≥70% of days.

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Figure 1. Frequency of average daily duration of home non-invasive ventilation among patients with chronic hypercapnic respiratory failure.

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Thirty-two patients (33.8%) reported adverse effects that occasionally interfered with the use of home NIV. The total number of adverse effects associated with NIV was inversely correlated with the percentage of days on which home NIV was used for ≥4 h/day (Spearman's ρ = −0.351, P = 0.004). The following adverse effects were inversely associated with use of home NIV for ≥4 h/day on ≥70% of days: machine noise (P = 0.001), difficulty in breathing (P = 0.004), conjunctivitis (P = 0.004), excessively high air pressure (P = 0.006), sleep disturbance (P = 0.017) and headache (P = 0.029). Increased repeat use of acute NIV during the compliance study period was correlated with a lower percentage of days of home NIV use for ≥4 h/day (Spearman's ρ = −0.257, P = 0.042).

In conclusion, poor compliance with home NIV is associated with greater numbers of adverse effects. Further prospective studies are required to investigate potential interventions that could improve compliance with and outcomes of home NIV.

ACKNOWLEDGEMENT

  1. Top of page
  2. Abstract
  3. ACKNOWLEDGEMENT
  4. REFERENCES

Part of this study was presented in abstract form at the European Respiratory Congress, Amsterdam, 2011.

REFERENCES

  1. Top of page
  2. Abstract
  3. ACKNOWLEDGEMENT
  4. REFERENCES