Non-invasive Home Mechanical Ventilation Research Articles

Lived experiences of caregivers with infants treated at home with continuous invasive or noninvasive ventilation.

Caring for children dependent upon continuous invasive ventilation in the home setting requires extensive expertise, coordination, and can result in impaired caregiver quality of life. Less is known regarding the experiences of caregivers with children requiring continuous noninvasive ventilation. To evaluate caregiver experiences with invasive and noninvasive home mechanical ventilation, and to compare parental quality of life based on the child's mode of ventilation. Caregivers of infants who were discharged home with continuous ventilatory support were recruited to complete semi-structured qualitative interviews. Interviews explored their decision-making process, the transition to home, and health related quality of life. Caregivers of 16 children were interviewed, of whom eight were treated with continuous invasive ventilation, and eight with continuous noninvasive ventilation. The decision to pursue home ventilation in both groups was greatly influenced by the desire to be discharged and reunite the family at home. Following the transition to home, caregivers from both groups described high rates of insomnia, emotional distress, work disruption and familial hardship. Despite this, parents were overwhelmingly pleased with the decision to proceed with home ventilation and perceived their children to be living enriched lives outside of the hospital. Factors associated with easing the transition to home were in-hospital training and the presence of a robust support system. Lives of families with children dependent on continuous mechanical ventilation are characterized by isolation, lifestyle disruption, adverse mental and physical health consequences, and impaired interpersonal relationships, irrespective of the mode of ventilation.

Positive impact on childrenÓ?s quality of life under non-invasive home mechanical ventilation - PedsQL application in a monocentric cohort

Positive impact on childrenÓ?s quality of life under non-invasive home mechanical ventilation - PedsQL application in a monocentric cohort

Noninvasive Home Mechanical Ventilation for Stable Hypercapnic COPD: A Clinical Respiratory Review from Canadian Perspectives.

Acute short-term noninvasive ventilation (NIV) for hypercapnic respiratory failure in chronic obstructive pulmonary disease (COPD) has well-established benefits; however, the role of long-term home NIV remains controversial. In the past decade, studies utilizing aggressive NIV settings to maximally reduce carbon dioxide levels (PaCO2) have resulted in several positive clinical trials and led to updated guidelines on home NIV for stable hypercapnic COPD patients. This clinical respiratory review discusses the high-intensity NIV approach, summarizes recent key trials and guidelines pertaining to home NIV in COPD, and considers key clinical questions for future research and application in the Canadian context. With recent evidence and Canadian Thoracic Society (CTS) guidelines supporting the use of NIV in carefully selected COPD patients with persistent daytime hypercapnia, we believe it is time to reconsider our approach.

Certification by the German Society for Neurorehabiliation, DGNR : Performance and quality of the "Centers for weaning from aventilator in early neurological and neurosurgical rehabilitation"

Certification of centers for weaning from aventilator in neurological neurosurgical early rehabilitation (NNER) by the German Society for Neurorehabilitation (DGNR) is possible since 1 October 2021. The results of certification of facilities in the first year after starting the procedure are presented. As part of the certification process 28criteria are assessed including aset of mandatory characteristics of the facility. The criteria are divided into structural criteria (i = 7), diagnostic criteria (i = 6), personnel criteria (i = 3), internal organization criteria (i = 7), and quality management criteria (i = 5). A total of 13 centers were certified in the first year, with acombined total of 283 beds for weaning from aventilator in the NNER and served 2278 persons to be weaned from aventilator in the year before certification, with amedian of 134 per facility (range 44-414). Only rarely was weaning unsuccessful, requiring conversion to home mechanical ventilation before discharge (invasive home mechanical ventilation median per facility 10persons, range 2-25; non-invasive home mechanical ventilation median 0persons, range 0-57). Ahigh level of process and structural quality was documented for the certified centers: across all areas of assessment, the individual certification criteria were met in the vast majority of cases (median degree of complete fulfilment 86%) or met with improvement potentials documented by the auditors (median 11%). Successful weaning in NNER and ahigh level of process and structural quality can be demonstrated by the certification results of centers that follow this integrative approach to weaning from aventilator in aNNER setting.

Role of respiratory characteristics in treatment adherence with noninvasive home mechanical ventilation in myotonic dystrophy type 1, a retrospective study

Chronic respiratory insufficiency is common in patients with myotonic dystrophy type 1 (DM1) and can be treated with noninvasive home mechanical ventilation (HMV). HMV is not always tolerated well resulting in low treatment adherence. We aimed to analyze if baseline respiratory characteristics such as pulmonary function, level of pCO2 and presence of sleep apnea are associated with HMV treatment adherence in DM1 patients. Pulmonary function testing, polysomnography and blood gas measurement data of DM1 patients were retrospectively collected. Initiation of HMV and treatment adherence after one year was documented. Patients with low treatment adherence (average daily use of HMV <5 h) were grouped with patients that discontinued HMV and compared with patients with high treatment adherence (average daily use of HMV >5 h). HMV was initiated in 101 patients. After one year, 58 patients had low treatment adherence. There were no differences between the low and high treatment adherence group regarding the respiratory characteristics. None of the included predictors (gender, age, body mass index, cytosine-thymine-guanine repeat length, FVC, daytime pCO2, bicarbonate, nighttime pCO2, nighttime base excess, apnea-hypopnea index and mean saturation during sleep) was able to significantly predict high treatment adherence. In conclusion, the respiratory characteristics are not associated with treatment adherence with HMV in DM1 patients and cannot be used to identify patients at risk for low HMV treatment adherence.

Toward a safe home: Experiencing the transition to an outpatient setting with home mechanical ventilation. A thematic analysis

Toward a safe home: Experiencing the transition to an outpatient setting with home mechanical ventilation. A thematic analysis Abstract. Background: With the progress in medical options, the need for home mechanical ventilation increases. The transition from long-term ventilation in an institution to home mechanical ventilation in an outpatient setting is a difficult phase in terms of setting up the network of care, coordination of care for those with the ventilatory insufficiency and the financing. Aim: The study describes how patients with ventilatory insufficiency and family caregivers experience the transition from an institution to an ambulatory setting with invasive or non-invasive home mechanical ventilation. Methods: A qualitative research design with a social-constructivist approach was adopted using thematic analysis according to Braun and Clarke. We included seven German-speaking patients (≥ 18 years old) with ventilatory insufficiency and home mechanical ventilation (> 6 h/day) from the German part of Switzerland, with discharge from an institution to home, and five family caregivers who care for patients with the described criteria. Results: The institution was seen as a safe place. Affected persons and their family caregivers had to create a safe environment at home. Three themes were formed inductively: To gradually build trust with each other, to become experts as family caregivers, to align their own network with the new care needs.Conclusions: The transition home succeeds in the interplay of gaining trust, building expertise, and creating sustainable networks. Professionals can use this knowledge to provide targeted support to patients with home mechanical ventilation and their family caregivers.

Moving from Inpatient to Outpatient or Home Initiation of Non-Invasive Home Mechanical Ventilation.

Home mechanical ventilation (HMV) is an effective treatment for patients with chronic hypercapnic respiratory failure caused by restrictive or obstructive pulmonary disorders. Traditionally, HMV is initiated in the hospital, nowadays usually on a pulmonary ward. The success of HMV, and especially non-invasive home mechanical ventilation (NIV), has led to a steep and ongoing increase in the incidence and prevalence of HMV, in particular for patients with COPD or obesity hypoventilation syndrome. Consequently, the number of available hospital beds to accommodate these patients has become insufficient, and models of care that minimize the use of (acute) hospital beds need to be developed. At present, the practices for initiation of NIV vary widely, reflecting the limited research on which to base model-of-care decisions, local health system features, funding models, and historical practices. Hence, the opportunity to establish outpatient and home initiation may differ between countries, regions, and even HMV centres. In this narrative review, we will describe the evidence regarding the feasibility, effectiveness, safety, and cost savings of outpatient and home initiation of NIV. In addition, the benefits and challenges of both initiation strategies will be discussed. Finally, patient selection and execution of both approaches will be examined.

What Circuits, Masks and Filters Should Be Used in Home Non-Invasive Mechanical Ventilation.

Most of the published reviews about non-invasive home ventilation mainly reflect the technical aspects of ventilators. There is much less information about the consumables most used at home. However, the choice of a good interface or tubing system can lead to physiological changes in the patient-ventilator interaction that the clinician should be aware of. These physiological changes may affect the performance of the ventilator itself, the reliability of monitoring and, of course, the comfort of the patient. The use of different circuits, masks or filters is therefore related to the concepts of rebreathing, compressible volume, instrumental dead space or leak estimation and tidal volume. Through certain bench experiments, it is possible to determine the implications that each of these elements may have in clinical practice.

Predictors of early hospital readmission in patients receiving home mechanical ventilation

BackgroundAlthough the proportion of patients with chronic respiratory failure requiring home mechanical ventilation (HMV) is increasing, hospital readmissions in these patients are also increasing. ObjectiveWe investigated the factors for early readmission in patients receiving HMV. MethodsWe retrospectively analyzed the data of adult patients readmitted to the hospital within a year who first received HMV and were discharged from the Asan Medical Center between March 2014 and February 2019. We compared the clinical characteristics at discharge before readmission between the early (readmission within 30 days) and late readmission groups (readmission between day 31 and 1 year) and investigated the clinical characteristics and outcomes at readmission. ResultsOf the 116 patients identified, 36.2% had been readmitted early. The patients who received invasive HMV had a higher rate of early readmission than those who received non-invasive HMV. Pneumonia was the most common reason of readmission in the two groups. The rate of aspiration was significantly higher in the early readmission group (28.6% vs. 8.1%; P = .003). In multivariate logistic regression analysis, nasogastric tube feeding, sequelae of pneumonia or acute respiratory distress syndrome, and central nervous system disorders as causes for HMV were significantly associated with early readmission. ConclusionFeeding methods and causes for HMV were associated with early readmission. Educating caregivers on respiratory care (suction and feeding methods) is important for preventing early readmission.

Invasive and Non-Invasive Home Mechanical Ventilation in Germany - A Rapid Development with Large Regional Differences

The number of patients using home mechanical ventilation (HMV) is steadily increasing in Germany. Detailed data on inpatient initiation and control of HMV are not available. This, however, is absolutely necessary in order to optimize the medical care structures in Germany. Regional diversities must be taken into consideration in order to provide care structures that reflect the local needs. The data sets of the German Federal Statistical Office on the OPS (Operation and Procedure Classification System) for HMV from 2008 to 2019 were analysed (N = 572,494). Between 2008 and 2019 there was a doubling of the number of HMV initiations and controls. The number of initiations (N = 17,958) and controls (N = 49,140) was highest in 2019. Furthermore, at the state level, the development of HMV is very heterogeneous. Finally, the increases were particularly due to an increase in non-invasively ventilated patients. The rapid increase in HMV is reaching capacity limits of the existing healthcare structure. New healthcare structures should provide an integrated approach between outpatient and inpatient care in order to ensure a high quality of care for patients receiving HMV without compromising the human and economic resources of the system.

Difficulties experienced by geriatric patients regarding respiratory devices and access to health services: A cross-sectional study

Background/Aim: In the treatment of chronic respiratory failure, long-term oxygen therapy at home (LTOT) and domiciliary noninvasive mechanical ventilation (NIV) are important components of home care. The aim was to evaluate the compliance of geriatric patients with LTOT/NIV at home and their access to health services in the last year. Methods: Screening of 669 patients who were hospitalized in our pulmonary intensive care unit between 30.09.2019 and 30.09.2020 revealed a total of 109 patients over 80 years of age with chronic respiratory failure. Among them, 70 died after discharge. Six of the 39 surviving cases were excluded from the study because they were discharged without any LTOT and/or NIV devices, and the COVID-19 PCR tests of 4 patients were positive after discharge. The remaining 29 patients over 80 years of age were enrolled in the study. After questioning the patient's care status, caregivers were asked whether the patients were compliant with NIV and/or LTOT devices at home and their usage in terms of hours during the day and nighttime. In non-compliant patients, the reasons were acquired, and the answers were noted. They were asked whether they gave up on healthcare services and scheduled check-ups, had difficulties in getting a doctor's appointment, and whether they were incompliant with the appointments they made. If the answers were yes, they asked about their reasons for each question. Results: The median age was 85 (80-96) years, and 65.5% (n=19) of the cases were female. The diagnosis which led to hospitalization in 86.2% (n=25) of the patients was hypercapnic respiratory failure. Fifteen patients (51.7%) with LTOT and 9 patients (81.8%) with NIV did not use their devices as recommended. The patients' caregivers expressed that 22 patients (75.8%) could not meet their basic needs and 17 patients (77.2%) did not receive home care services provided by the Ministry of Health. Although the need arose in the post-discharge period, it was observed that 24 patients (82.7%) were not taken to the doctor and 20 patients (68.9%) did not schedule doctor visits after discharge. All caregivers stated that they were afraid of the COVID-19 pandemic and catching the COVID-19 disease from the emergency rooms and outpatient clinics. Conclusions: Our patients' compliance with the LTOT device was poor and 51.7% of the patients used the device less than recommended. Moreover, the patients were mostly incompliant with domiciliary NIV treatment. Receiving nonspecific home care services did not have any effect on LTOT and/or NIV compliance. It was observed that disruption in doctor visits and patient admissions leads to the decreased compliance with LTOT and/or NIV devices and loss of motivation to use these devices. The cases in this study avoided all kinds of admissions to the hospital due to the COVID-19 pandemic. In such conditions, structured and specific home care services for geriatric respiratory failure patients become more important. Continuing education and motivation at home will increase the quality of life of the patients and improve compliance.

New Insights in Adherence and Survival in Myotonic Dystrophy Patients Using Home Mechanical Ventilation

Background: Non-invasive home mechanical ventilation (HMV) is a complex treatment in myotonic dystrophy type 1 (DM1) patients, due to a presumed poor adherence, variable symptom improvement, and uncertainty regarding survival benefits. Objectives: We aimed to investigate indications, adherence to HMV and its effects on mortality in a large cohort of DM1 patients. Methods: In this retrospective cohort study, we evaluated 224 DM1 patients. Different groups based on hypercapnia and HMV treatment were compared. Cox regression analyses were performed to compare mortality between different defined groups. Results: 224 patients were analysed of whom 111 started non-invasive HMV. Indications were daytime hypercapnia (n = 75), only nocturnal hypercapnia (n = 33), or other reasons (n = 3). Adequate adherence (≥4 h/night) was found in 84.9% of patients. Adequate ventilation was reached in 86.5% of patients. In 33 patients (29.7%), HMV was stopped prematurely due to not reaching patients’ expectations on symptom relief or treatment burden (n = 22), or intolerance (n = 8), or other reasons (n = 3). HMV did not improve survival in daytime hypercapnic patients (p = 0.61) nor in nocturnal hypercapnia patients compared to daytime hypercapnia (p = 0.21). Significant survival benefits after starting HMV were found for patients with HMV adherence ≥5 h/24 h compared to patients who used HMV less. Conclusion: In this large cohort, daytime hypercapnia is the main reason for starting HMV, which is well tolerated and used. Mortality is not associated with the reason why HMV was started, but once started, patients with ≥5 h/24 h adherence have significantly better survival compared to patients who use it less.

Home mechanical ventilation: quality of life patterns after six months of treatment

BackgroundIt has been shown that home mechanical ventilation improves quality of life, but it has not been widely studied which particular patient groups benefit the most from starting this type of therapy. The purpose of this prospective observational study was to evaluate quality of life change patterns 6 months after initiation of home mechanical ventilation in patients suffering from chronic respiratory failure using patient reported outcomes.MethodsWe enrolled 74 chronic respiratory failure patients starting invasive or noninvasive home mechanical ventilation through the Semmelweis University Home Mechanical Ventilation Program. Quality of life was evaluated at baseline and at 6 months after initiation of home mechanical ventilation using the Severe Respiratory Insufficiency Questionnaire.ResultsOverall quality of life showed 10.5% improvement 6 months after initiation of home mechanical ventilation (p < 0.001). The greatest improvement was observed in Respiratory complaint (20.4%, p = 0.015), Sleep and attendant symptoms (19.3%, p < 0.001), and Anxiety related subscales (14.4%, p < 0.001). Interface (invasive versus noninvasive ventilation) was not associated with improvement in quality of life (p = 0.660). Severely impaired patients showed the greatest improvement (CC = -0.328, p < 0.001). Initial diagnosis contributed to the observed change (p = 0.025), with chronic obstructive pulmonary disease and obesity hypoventilation syndrome patients showing the greatest improvement, while amyotrophic lateral sclerosis patients showed no improvement in quality of life. We found that patients who were started on long term ventilation in an acute setting, required oxygen supplementation and had low baseline quality of life, showed the most improvement during the six-month study period.ConclusionsOur study highlights the profound effect of home mechanical ventilation on quality of life in chronic respiratory failure patients that is indifferent of ventilation interface but is dependent on initial diagnosis and some baseline characteristics, like acute initiation, oxygen supplementation need and baseline quality of life.Trial registrationThis study was approved by and registered at the ethics committee of Semmelweis University (SE TUKEB 251/2017; 20th of December, 2017).

The effects of home noninvasive ventilation on the quality of life and physiological parameters of patients with chronic respiratory failure.

Home noninvasive mechanical ventilation (HNIV) in patients with chronic hypercapnic respiratory failure (CHRF) may improve the health-related quality of life (HRQoL) and reduce hospitalizations. To determine the effects of HNIV on HRQoL, sleep quality and hospitalization rates in restrictive thoracic diseases (RTD) and chronic obstructive pulmonary disease (COPD) patients with CHRF. In this prospective, single center study patients divided into two groups; the COPD and the RTD groups. HRQoL assessed by The Medical Outcome Study 36-Item Short-form Health Survey (SF-36) and Severe Respiratory Insufficiency (SRI); the sleep quality was assessed by Epworth and Pittsburgh Sleep Quality Index questionnaires. The patients were reevaluated first month, third months, sixth months and 1 year following HNIV establishment, during which time, hospitalization rates were recorded. Ninety (COPD n=50, RTD n=40) out of 102 eligible patients completed the study. Significant improvements in blood gases and HRQoL were observed in the first month of HNIV establishment and remained stable. Mean±SD SRI summary scale improved significantly from 30±12 baseline to 65±16 at 1year in COPD group (P<0.001) and from 39±13 to 63±18 in RTD group (P<0.001). HNIV reduced hospitalization rates from a mean of 1.9±1.1 to 0.5±0.9 in COPD group (P<0.001) and a mean of 1.9±1 to 0.5±0.7 in RTD group (P<0.001). HNIV improves HRQoL, sleep quality and gas exchange and reduces hospitalizations in patients with CHRF regardless of etiology.

Technological advances in home non-invasive ventilation monitoring: Reliability of data and effect on patient outcomes.

Home non-invasive mechanical ventilation (NIV) has become a well-established treatment for patients with chronic hypercapnic respiratory failure. NIV monitoring has been developed to evaluate the effectiveness of mechanical ventilation on patient outcomes, with built-in systems providing data on compliance, leaks and respiratory parameters. Although these data seem intuitively useful, two main concerns have been raised in the literature: (i) are they reliable and (ii) to what extent does their use improve patient outcomes. These two concerns are currently relevant since the very recent development of telemonitoring provides the possibility of adjusting ventilator settings remotely, based on the longitudinal assessment of NIV parameters and respiratory variables provided by the system. This may influence the future management strategies of health organizations for patients under home NIV. This narrative review describes technological advances in patient monitoring using home mechanical ventilation with a main focus on data provided by built-in NIV monitoring systems. The use of these systems is discussed, including their advantages and limitations in different clinical situations, and perspectives for long-term patient monitoring are discussed.

Beneficial effect of nocturnal oximetric control on the clinical and gasometric situation and the prognosis of patients with home non-invasive mechanical ventilation

Introduction and objectiveThe effectiveness of home non-invasive mechanical ventilation (NIMV) is assessed by determining blood gas values in wakefulness, the evolution of their symptoms, and the monitoring of ventilation at night. The aim of our study is to evaluate whether defined values reached with outpatient monitoring by oximetry is related to the clinical, arterial gases and survival of a sample of patients with home NIMV. Material and methodRetrospective observational cohort study of a series of patients receiving home NIMV treatment for different causes. Patients with amyotrophic lateral sclerosis and less than 3 months of follow-up were excluded. The evolution of the patient's symptoms, their baseline arterial blood gases in wakefulness, and home nocturnal oximetry records, are evaluated at each outpatient visit. Good maintained oximetry control (MOC) was defined when mean O2 saturation values were reached and maintained until the last revision. Patient groups were considered, according to whether or not a good MOC was achieved during follow-up. ResultFour hundred patients were evaluated. Three hundred and sixty four (91%) were included in the study; their median age was 68 years, 51% were male. 37.6% had a good MOC during follow-up. Compared to patients with not good MOC, a better long-term mortality was obtained (16.8% vs 28.2%, p=0.013), and an improvement in symptoms (33.8% vs 18.6%, p=0.002) and a lower proportion of patients with persistently >50mmHg PaCO2 (14.2% vs. 33.9%, p<0.001) was observed. ConclusionIn the follow-up of patients with home NIMV in our context, values defined in home nocturnal oximetry (good MOC) are positively associated with clinical, gasometric and longer-term survival.

Pneumothorax in chronically ventilated neuromuscular and chest wall restricted patients: A case series

RATIONALE: Pneumothorax can occur in chronically ventilated neuromuscular and chest wall-restricted patients using noninvasive home mechanical ventilation (HMV) and airway clearance techniques. Limited descriptions of these cases and their management exist in the literature.OBJECTIVES: To understand the unique considerations in diagnosis and management of pneumothorax in the neuromuscular and chest wall-restricted patient population.METHODS: A retrospective chart review was performed at the Peter Lougheed Neuromuscular Respiratory Clinic between 2006 and 2017. A case series of six patients is presented.RESULTS: Median duration of HMV at time of the pneumothorax was 3 years (range 0.25-9 years). Five patients used airway clearance techniques. The mean forced vital capacity (FVC) was 1.0 L (27% predicted). Patients had a low mean body mass index (BMI) of 16 ± 3 kg/m2. Five of 6 patients required chest tube and had prolonged air leak (>48 hours). Four of 6 had recurrent pneumothoraces. One patient received chemical pleurodesis.CONCLUSIONS: Clinical suspicion and rapid diagnosis are necessary for pneumothorax in neuromuscular and chest wall-restricted patients dependent on HMV. CT imaging of the chest may be necessary. Management can include: reducing ventilator pressure settings, suspending airway clearance techniques and chest tube insertion. Chemical or surgical pleurodesis are felt to be high risk; however, recurrent pneumothorax was frequent in this cohort. Low BMI raises the possible association between malnutrition and risk of pneumothorax in patients receiving HMV.

Relación del buen control oximétrico mantenido con la situación clínica, gasométrica y el pronóstico de los pacientes con ventilación mecánica no invasiva domiciliaria

Introduction and objectiveThe effectiveness of home non-invasive mechanical ventilation (NIMV) is assessed by determining blood gas values in wakefulness, the evolution of their symptoms, and the monitoring of ventilation at night. The aim of our study is to evaluate whether defined values reached with outpatient monitoring by oximetry is related to the clinical, arterial gases and survival of a sample of patients with home NIMV. Material and methodRetrospective observational cohort study of a series of patients receiving home NIMV treatment for different causes. Patients with amyotrophic lateral sclerosis and less than 3 months of follow-up were excluded. The evolution of the patient's symptoms, their baseline arterial blood gases in wakefulness, and home nocturnal oximetry records, are evaluated at each outpatient visit. Good maintained oximetry control (MOC) was defined when mean O2 saturation values were reached and maintained until the last revision. Patient groups were considered, according to whether or not a good MOC was achieved during follow-up. ResultFour hundred patients were evaluated. Three hundred and sixty four (91%) were included in the study; their median age was 68 years, 51% were male. 37.6% had a good MOC during follow-up. Compared to patients with not good MOC, a better long-term mortality was obtained (16.8% vs 28.2%, P=.013), and an improvement in symptoms (33.8% vs 18.6%, P=.002) and a lower proportion of patients with persistently>50mmHg PaCO2 (14.2% vs. 33.9%, P<.001) was observed. ConclusionIn the follow-up of patients with home NIMV in our context, values defined in home nocturnal oximetry (good MOC) are positively associated with clinical, gasometric and longer-term survival.

Caracterización socio-demográfica y clínica de pacientes adultos en ventilación mecánica no invasiva domiciliaria. Ministerio de Salud. Chile

Introduction: Non-invasive home mechanical ventilation (NIHMV) is delivered in Chile since 2008 throughout a public program, including equipment and professionals. Objectives: 1) Characterize the socio-demographic and clinical profile of the adult patient under NIHMV and 2) Propose improvements in social health care. Methodology: Descriptive cross-sectional study, through face-to-face home interview and review of official databases. Sample of 267 subjects, both gender, over 20 years-old, with Chronic Global Respiratory Failure (CGRF) in NIHMV. In 2016 there were 413 active patients. Results: Women 144 (53.9%), mean age 58.6 ± 18 years-old; 25.5% had COPD and 24% had a hypoventilation obesity syndrome, average PaCO2 at the time of admission to program was 59 ± 11 mmHg, they were ventilated since 3.2 ± 2.4 years, 7.6 ± 2.4 h a day. Subjects “without instruction” and with “incomplete basic education” represents 40.7% of the sample. 46.4% were retired persons; 3% lived in a precarious hut; 19.8% cohabited with relatives or close friends; 49% did not have a partner; 4.8% lived alone; 68.6% was oxygen dependent; 40% had an altered Golberg test; 17.7% “has a major limitation, unable to perform self-care”. Conclusions: Our patients have a severe socio-demographic and clinical deterioration, due to low schooling level, predominance of older adults, a major incapacity for working and patients have a more severe disease with higher baseline PaCO2 levels, compared to European studies. NIHMV programs must adopt a social health approach and be inserted into the health network in social service, and cardiovascular and mental health programs.

Erfahrungen außerklinisch invasiv und nicht invasiv beatmeter Menschen – eine systematische Literaturrecherche qualitativer Forschungen

Human beings can be ventilated outside of a hospital after a lung failure or due to a neurodegenerative disease. This can be done in different living conditions. This article examines the question of what experiences such patients have made with invasive home mechanical ventilation, and how they have adapted their new lives. On the basis of a systematic literature research, qualitative studies were analyzed that depict the social reality of patients with invasive and non-invasive home mechanical ventilation. Eleven international studies with a qualitative research design could be identified. Studies that investigate the experiences of patients with invasive ventilation in Germany have not yet been published. The analysis led to the following topics: experiencing the start of ventilation, living with ventilation, safety, family life, stigmatization and a life with dependence, but self-determined. Human beings who need to be out of hospital an invasive or non-invasive ventilation, it is difficult to decide for the ventilation and the right time to begin it. With the ventilation, they then connect a positive feeling of life. To enable a self-determined and active life to humans with invasive ventilation, it is important for health care providers to know the needs and to adapt to them individually.