Does relationship exist between domiciliary non-invasive ventilation (NIV) and frequency of hospital admissions in patients with chronic type 2respiratory failure?

Abstract

Introduction

Recurrent hospital admissions due to decompensated type 2 respiratory failure have negative impact on patient's quality of life and hospital capacity issues therefore we decided to investigate whether providing nocturnal domiciliary NIV to such patients decrease hospital admissions or not.

Method

We retrospectively analysed records of 120 patients who were started on domiciliary NIV at Sandwell and West Birmingham NHS trust between years 2009-12. We checked difference in frequency of hospital admissions before and after initiation of domiciliary NIV.

Results

66 patients (38 males, 28 females) with mean age of 61.6(24-86) years were included in final analysis as 37/120 patients died and 17/120 patients were withdrawn from NIV. The major indication for NIV includes OHS (n=30), neuromuscular disease (n=10), Musculoskeletal disorder (n=9) and COPD (n=17).

The average number of hospital admissions per patient reduced from 1.3(range 0-9, SD 1.868) to 0.359(range 0-5, SD:0. 9815) after initiation of domiciliary NIV suggesting positive outcome but difference did not achieve statistical significance (p=0.9997). Subgroup analysis showed reduction in hospital admission in all groups, COPD (2.812 VS. 0.81,p=0.99), OHS (0.9 VS. 0.2, p=0.99) and both NMD and MSD (0.66 VS. 0.22, p=0.95).

Conclusion

Domiciliary NIV intervention resulted in reduction in hospital admissions in patients with chronic type 2 respiratory failure but statistical significance was not achieved. A prospective study looking into impact of domiciliary NIV on hospital admission frequency and quality of life is needed to evaluate this further.