Home non-invasive ventilation in the Canton of Geneva: ventilators, modes, interfaces

Abstract

Practices regarding home non-invasive ventilation (HMV) have changed since the last study published in the Geneva area (1). Population, ABG and modalities of medical follow-up are reported in another abstract. Methods: Survey of all cases aged >20 years treated by HMV for >3 months in the Canton of Geneva; collection of data regarding ventilators, interfaces and modes through public and private hospitals, private practicioners, and home care providers. Results: (Median, range, or N, % of total): 357 patients (aged 71 (20-95) years) included (5 refusals). Diagnoses: obstructive lung disorders: 89(26%); restrictive lung disorders: 89 (26%); neuromuscular diseases (NMD): 36 (10.6%); sleep-related breathing disorders (SRBD): 125 (36.8%); missing data: 17. Patients had been on HMV for 37.6 months (3-347). Ventilator modes used: Bi-level positive pressure (BPPV; 241, 67.5%); Adaptive Servo Ventilation (ASV, 113; 31.7%, mostly ASV-CS mode); volumetric ventilation (3; 0.8%). 125 patients (35%) had been put on HMV after failure of nCPAP. Interfaces (missing data: 20): nasal masks (68; 20.2%), nasal prongs (21; 6.2%), facial masks (248; 73.6%); daytime mouth-piece (1;0.3%). 229 patients (64%) used a humidifier. Ten patients (2.8%) had a 2nd ventilator provided; 2 had an external battery. O 2 was added to NIV in 93 (26%) cases. Six (1.8%) had a Cough Assist, and 1 used an IPPB device. Conclusions: BPPV is the main mode of HMV. Volumetric ventilation has virtually disappeared, despite a 10.6% of the population with NMD. Conversely, ASV is widely used (1/3 of devices used for HMV). Use of ASV-CS must be reevaluated at the light of the SERVE-HF results. 1. JP Janssens; Chest 2003; 123:67-79