Home non-invasive ventilation in the Canton of Geneva: population and follow-up

Abstract

Organisation and practices regarding home non-invasive ventilation (HMV) have changed since the last study published in the Geneva area in 2003 (1). Methods: Survey of all cases aged>20 years treated by HMV for >3 months in the Canton of Geneva; collection of data regarding patient (diagnosis, ABG), and follow-up, through public and private hospitals, private practicioners, and home care providers. Results: (Median, range, or N, %): 357 patients (232 Male, 65%; aged 71 (20-95) years) included (5 refusals). Prevalence of NIV in Geneva for patients aged>20: 93.3/10E5 inhabitants. Median BMI : 31.2 kg/m 2 (12.4-71.7); BMI 2 : 10%, >30 kg/m 2 : 54%, and >40: 18.5%. Most recent ABG without NIV (n=208): pH: 7.41 (7.3-7.51); PaCO 2 : 5.5 kPa (3.8-9.1); PaO 2 : room air (n=178): 9.1 kPa (4.8-14.3); HCO3: 26.3 mmol/L (14.6-41.9). Daytime PaCO 2 >6.5 kPa in 18% of cases. Diagnoses (missing: 17): obstructive lung disease: 89 (26%); restrictive disorders: 89 (26%; 20% OHS); neuromuscular disorders: 36 (10.6%); sleep-related breathing disorders: 125 (36.8%); palliative NIV: 1. Initiation : after acute episode of respiratory failure (105; 32%) ; electively (224; 68%) ; in hospital (216; 67.5%) ; as outpatient (104; 32.5%). Medical follow-up: private pulmonologist (168; 47%); expert center (179; 50%); both (10; 3%); 50 patients (15%) had not seen a pulmonologist within the past year. Regular home visits by specialized nurses : 197 (55%) patients. O 2 during NIV : 93 cases (26%). Conclusion: COPD and OHS remain the most frequent indications for NIV in our area. More than 50% of patients are obese. Involvement of private practitioners in HMV is important; 1/3 of cases are started as outpatients 1. Janssens JP, Chest 2003; 123:67-79