Adaptation to noninvasive ventilation in an outpatient setting: our experience

Abstract

The current gold standard for home mechanical ventilation (HMV) initiation is during an inpatient period. The widening indications for HMV in a resources-limited system made exclusive inpatient initiation, adaptation and follow up impracticable. For almost 10 years our center developed a protocol for patient follow up in an outpatient setting and later initiation of HMV. The HMV outpatient clinic consists of a pulmonologist, a nurse and the presence of a technician from the home respiratory care company (provider of NIV in Portugal). At initiation willing patients are adapted and titrated to NIV for a period of at least 1h with blood gas analysis and/or capnography with the ventilator they will take home, if tolerated. Patients are re-evaluated at 15 days to 1 month and 3 months and have regular home visits by the company. Between 01/2018 and 06/2019, 88 patients started HMV, 49 patients in an outpatient setting (55.7%), the remainder were adapted as inpatient during an exacerbation. No deaths, need for inpatient adaptation or complications of HMV  were recorded during the first 3 months. Our experience with outpatient initiation on HMV has proven to be feasible, safe and effective in reducing hypercapnia.