Chest
Volume 123, Issue 1, January 2003, Pages 67-79
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Clinical Investigations
NPPV
Changing Patterns in Long-term Noninvasive Ventilation: A 7-Year Prospective Study in the Geneva Lake Area

https://doi.org/10.1378/chest.123.1.67Get rights and content

Study objectives

To describe a 7-year follow-up (1992 to 2000) of patients who were treated by home nasal positive-pressure ventilation (NPPV) for chronic hypercapnic respiratory failure.

Design

Prospective descriptive study.

Setting

Two university hospitals and a pulmonary rehabilitation center.

Patients

Two hundred eleven patients with obstructive pulmonary disorders (58 patients) or restrictive pulmonary disorders (post-tuberculosis, 23 patients; neuromuscular diseases [NM], 28 patients; post-poliomyelitis syndrome, 12 patients; kyphoscoliosis [KYPH], 19 patients; obesity-hypoventilation syndrome [OHS], 71 patients) who were treated by long-term NPPV.

Intervention

Annual, elective, standardized medical evaluations.

Measurements

Pulmonary function tests, arterial blood gas levels, health status, compliance, survival and probability of pursuing NPPV, and hospitalization rates.

Results

Patients with OHS, NM, and KYPH had the highest probability of pursuing NPPV, while patients with COPD had the lowest values. Overall, the compliance rate was high (noncompliance rate, 15%). As of 1994, COPD and OHS became the most frequent indications for NPPV, increasing regularly, while other indications remained stable. The use of pressure-cycled ventilators progressively replaced that of volume-cycled ventilators in most indications. Hospitalization rates decreased in all groups after initiating NPPV, when compared with the year before NPPV, for up to 2 years in COPD patients, and 5 years in non-COPD patients.

Conclusion

Major changes in patient selection for NPPV occurred during the study period with a marked increase in COPD and OHS. The shift toward less expensive pressure-cycled ventilators and the decrease in hospitalizations after initiating NPPV have had positive impacts on the cost-effectiveness of NPPV in patients with chronic respiratory failure.

Section snippets

Materials and Methods

As of October 1992, all patients treated by home NPPV in the cantons of Geneva and Vaud (1,030,000 inhabitants [year 2000 census]) were prospectively included in a computerized database. Patients with tracheostomies were not included in this analysis. In Switzerland, the use of tracheostomy for long-term PPV is very restrictive (at present, < 5% of patients receive HMV).

Patients were started on NPPV therapy either after an acute episode of hypercapnic respiratory failure or electively, due to

Patients

Between October 1, 1992 and February 1, 2000, 211 patients receiving home NPPV therapy were included in the study database. The length of follow-up ranged from 1 to 88 months (median, 24 months). Patients were divided into six diagnostic categories (Table 1).

The COPD group included 58 patients who had obstructive lung diseases and hypercapnic respiratory failure due to the following: emphysema and/or chronic bronchitis (51 patients); severe bronchiectasis (4 patients); or cystic fibrosis (3

Discussion

The present study illustrates the changes that have occurred in home NPPV in the Geneva Lake area since the publication of the studies by Leger et al20 and Simonds and Elliott.19 Bilevel pressure-cycled ventilation has become the default mode of ventilation in most indications (Fig 3), with results similar to volume-cycled ventilation in terms of the correction of daytime hypercapnia, survival, probability of pursuing NPPV (Fig 4), and a major reduction in cost (prices of volume-cycled

Conclusion

Noninvasive ventilation has emerged over the past 15 years as a valuable therapeutic option for the long-term treatment of chronic alveolar hypoventilation in patients with restrictive pulmonary disorders and, to a lesser degree in COPD patients, with an acceptable QOL.355556 Compliance with NPPV therapy in these patients is remarkably high when compared to that with other modes of respiratory assistance such as LTOT or nasal CPAP.57585960 Tolerance to treatment is also quite good.61 The

ACKNOWLEDGMENT

We express our gratitude to Dr. Daniela Stefanutti, MD, from the Children's Hospital of Geneva University Hospital, for her contribution to this study.

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