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Home initiation of chronic high-intensity noninvasive ventilation in COPD patients with chronic hypercapnic respiratory failure: the RECONSIDER trial

Marieke L. Duiverman, Gerrie Bladder, Judith M. Vonk, Job F.M. Van Boven, Jellie Nieuwenhuis, Anda Hazenberg, Huib A.M. Kerstjens, Peter J Wijkstra
European Respiratory Journal 2019 54: RCT451; DOI: 10.1183/13993003.congress-2019.RCT451
Marieke L. Duiverman
1Department of Pulmonary Diseases/Home mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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  • For correspondence: m.l.duiverman@umcg.nl
Gerrie Bladder
1Department of Pulmonary Diseases/Home mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Judith M. Vonk
2Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Groningen, Netherlands
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Job F.M. Van Boven
3Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Jellie Nieuwenhuis
1Department of Pulmonary Diseases/Home mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Anda Hazenberg
1Department of Pulmonary Diseases/Home mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Huib A.M. Kerstjens
1Department of Pulmonary Diseases/Home mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Peter J Wijkstra
1Department of Pulmonary Diseases/Home mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Abstract

Background: Chronic high-intensity noninvasive ventilation (NIV) has become evidence based care for stable hypercapnic chronic obstructive pulmonary disease (COPD) patients. Since the number of patients is increasing, home initiation of NIV would greatly alleviate the healthcare burden.

Hypothesis: Home initiation of chronic high-intensity NIV in stable hypercapnic COPD is non-inferior to in-hospital initiation.

Methods: Sixty-seven patients with stable hypercapnic COPD were randomised between standard in-hospital NIV initiation or home NIV initiation using telemedicine. The primary outcome was daytime arterial carbon dioxide pressure (PaCO2) reduction after 6 months NIV, with a non-inferiority margin set at 0.4 kPa. Secondary outcomes were health-related quality of life (HRQoL) and costs.

Results: Home NIV initiation was non-inferior to in-hospital initiation (adjusted mean difference in PaCO2 change home vs. in-hospital at 6 months: 0.04 kPa (95% CI -0.3 to 0.4), with both groups showing a reduction in PaCO2 at 6 months compared to baseline (home: from 7.3 ± 0.9 to 6.4 ± 0.8 kPa (P<0.001); in-hospital: from 7.4 ± 1.0 to 6.4 ± 0.6 kPa (P<0.001)). There was no difference in improvement in HRQoL (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. hospital: median €8537 (IQR €7540-€9175); P<0.001).

Discussion: This is the first study showing that home initiation of high-intensity NIV in stable hypercapnic COPD patients is non-inferior to to in-hospital initiation, with over 50% savings of costs.

  • Mechanical ventilation - interactions and complications
  • Telemedicine
  • COPD - management

Footnotes

Cite this article as: European Respiratory Journal 2019; 54: Suppl. 63, RCT451.

This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).

  • Copyright ©the authors 2019
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Home initiation of chronic high-intensity noninvasive ventilation in COPD patients with chronic hypercapnic respiratory failure: the RECONSIDER trial
Marieke L. Duiverman, Gerrie Bladder, Judith M. Vonk, Job F.M. Van Boven, Jellie Nieuwenhuis, Anda Hazenberg, Huib A.M. Kerstjens, Peter J Wijkstra
European Respiratory Journal Sep 2019, 54 (suppl 63) RCT451; DOI: 10.1183/13993003.congress-2019.RCT451

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Home initiation of chronic high-intensity noninvasive ventilation in COPD patients with chronic hypercapnic respiratory failure: the RECONSIDER trial
Marieke L. Duiverman, Gerrie Bladder, Judith M. Vonk, Job F.M. Van Boven, Jellie Nieuwenhuis, Anda Hazenberg, Huib A.M. Kerstjens, Peter J Wijkstra
European Respiratory Journal Sep 2019, 54 (suppl 63) RCT451; DOI: 10.1183/13993003.congress-2019.RCT451
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