Abstract
Background. The prevalence of patients supported with home mechanical ventilation (HMV) for chronic respiratory failure has increased. However, the clinical outcomes associated with HMV are largely unknown. Methods. We performed a systematic review of studies evaluating patients receiving HMV for indications other than obstructive lung disease, reporting at least one clinically relevant outcome including health-related quality of life (HRQL) measured by validated tools; hospitalization requirements; caregiver burden; and health service utilization. We searched MEDLINE, EMBASE, CINAHL, the Cochrane library, clinical trial registries, proceedings from selected scientific meetings, and bibliographies of retrieved citations. Results. We included 1 randomized control trial (RCT) and 25 observational studies of mixed methodological quality involving 4425 patients; neuromuscular disorders (NMD) (n = 1687); restrictive thoracic diseases (RTD) (n = 481); obesity hypoventilation syndrome (OHS) (n = 293); and others (n = 748). HRQL was generally described as good for HMV users. Mental rather than physical HRQL domains were rated higher, particularly where physical assessment was limited. Hospitalization rates and days in hospital appear to decrease with implementation of HMV. Caregiver burden associated with HMV was generally high; however, it is poorly described. Conclusion. HRQL and need for hospitalization may improve after establishment of HMV. These inferences are based on relatively few studies of marked heterogeneity and variable quality.
Highlights
Home mechanical ventilation (HMV) is a viable and effective treatment strategy for patients with chronic respiratory failure and has been associated with a survival benefit [1,2,3].Provision of mechanical ventilation outside of an institution has been in effect for more than 50 years, originating during the polio epidemic [4]
The first theme included keyword/MESH headings related to disease states associated with chronic respiratory failure (CRF)
We searched the abstracts from key scientific proceedings (CHEST, American Thoracic Society and European Respiratory Society, 2010–2013), the bibliographies of all retrieved articles and recent reviews, and clinical trials registries
Summary
Home mechanical ventilation (HMV) is a viable and effective treatment strategy for patients with chronic respiratory failure and has been associated with a survival benefit [1,2,3].Provision of mechanical ventilation outside of an institution has been in effect for more than 50 years, originating during the polio epidemic [4]. The prevalence has increased, with the expanded utilization of HMV for a broad range of neuromuscular disorders (NMD), restrictive thoracic diseases (RTD), and obesity hypoventilation syndrome (OHS). The use of noninvasive ventilation (NIV) in stable chronic obstructive pulmonary disease (COPD) is an area of controversy This group accounts for approximately one-third of users in Europe; given insufficient and often conflicting data current, Canadian guidelines do not support widespread usage in this population. The prevalence of patients supported with home mechanical ventilation (HMV) for chronic respiratory failure has increased. We performed a systematic review of studies evaluating patients receiving HMV for indications other than obstructive lung disease, reporting at least one clinically relevant outcome including health-related quality of life (HRQL) measured by validated tools; hospitalization requirements; caregiver burden; and health service utilization. Caregiver burden associated with HMV was generally high; it is poorly described
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