Home NIV: results and lessons from a European survey

Abstract

The prevalence of chronic respiratory failure in Europe continues to rise, mostly because of an aging population demographic but also because of an increase in the uptake of smoking in Russia and the former Eastern Bloc countries [1, 2]. This has been accompanied by the expansion [3–5] over the last three decades in the use of home mechanical ventilation (HMV) to treat chronic hypercapnic respiratory failure. HMV is usually delivered as noninvasive ventilation (NIV), with the majority of patients using only nocturnal or nocturnal plus part-daytime NIV, and in many cases has been shown to reduce mortality and morbidity [6, 7] and to improve quality of life [8]. The magnitude of the rise in HMV is impressive, with the numbers of patients receiving home ventilatory support increasing from 130 patients, in one survey, in 1988 to 3,120 patients in 1998 [3]. This expansion has been driven by not only the growing population of individuals with chronic respiratory failure but also the increasing recognition that NIV can be of benefit in many different causes of ventilatory failure [9]. Technological advances have meant that ventilators are easier to use and that the interfaces are more comfortable. Additionally, HMV offers the individual the advantage of retaining an independent lifestyle and it offers the state a health–economic benefit as it is less costly when compared with invasive mechanical ventilation [10]. As well as the patient, there are industrial manufacturers and distributors of the machines, who will also benefit from the increasingly widespread use of HMV. It is, of course, important that the growth of HMV in Europe is on a properly planned basis and not simply driven by market considerations. However, it will be seen from the present chapter that the use of HMV in Europe is not presently standardised, regulated or consistent. The present chapter will describe and explore the wide variation in practises that occur within and between the countries of Europe with regards to HMV. Firstly, it will look at predominantly national surveys which took place in the 1990s before progressing to the most recent pan-European survey which took place in 2001–2002.