Home mechanical ventilation for restrictive thoracic diseases: effects on patient quality-of-life and hospitalizations

Abstract

Forty-five patients with restrictive respiratory diseases, including thoracic wall diseases (TWD, n = 27) and neuromuscular diseases (NMD, n = 18), underwent 18 months of home mechanical ventilation (HMV) treatment. Treatment consisted of a two-level pressure system for 7h at night, with oxygen available if needed. Questionnaire-based assessments of health-related quality-of-life (HRQL) were evaluated before treatment and at 3, 6, 9, 12 and 18 months of follow-up. Hospitalization rates pre- and post-treatment were recorded, and the numbers need to treat (NNT) to avoid hospitalization and absolute risk reduction (ARR) rates were calculated. Several categories of HRQL, including physical function and vitality, improved significantly with treatment in both groups of patients; these improvements persisted over the entire 18 months. In contrast, other categories such as social function and mental health improved initially and declined subsequently. Hospitalizations decreased significantly with treatment. NNT calculations indicated that treatment would be needed for two TWD patients (ARR 63%) and one NMD patient (ARR 78%) to prevent one hospitalization per year per disease group. We conclude that improved quality-of-life and decreased hospitalizations make home non-invasive mechanical ventilation an useful treatment for patients with restrictive respiratory disorders.

Noninvasive Ventilation in Chronic Respiratory Failure: Effects on Quality of Life

“…Patients with restrictive disorders have shown improvement in HRQoL after the establishment of NIV for 12 and 18 months [13,15,17]. We have extended this outcome over a period of 2 years.…”

“…This instrument has successfully been used to evaluate HRQoL in patients with different causes of CRF receiving domiciliary noninvasive mechanical ventilation [1,15,27,28], and our group has previous experience with COPD patients on NIV [16]. …”

“…In patients with COPD and CRF, there is an increased impact of the disease on the patients’ well-being, with the reduction in daily activities being one of the main consequences [7]. Studies have shown that NIV has a positive impact on HRQoL, regardless of the underlying cause of CRF [1,5,8,9,10,11,12,13,14,15,16,17]. However, the most recent randomized controlled trial of NIV in COPD patients has shown an improvement in survival, yet at the cost of worsening quality of life [18].…”

Impact of Ventilation Parameters and Duration of Ventilator Use on Non-Invasive Home Ventilation in Restrictive Thoracic Disorders

“…Among the latter, frequent causes are kyphoscoliosis and post-tuberculosis syndrome, characterized by decreased chest wall compliance and impaired respiratory mechanics, leading to progressive hypoventilation and hypercapnia [7]. For such patients, a number of studies have been published in the past several years reporting that NPPV is not only able to improve blood gas parameters but also hemodynamics, exercise performance, sleep quality and health-related quality of life [8,9,10,11,12,13,14,15]. Nevertheless, different effects of NPPV on lung volumes and inspiratory muscle function have been found [8,9,10, 12,16,17,18,19,20,21,22,23,24].…”

Home mechanical ventilation in Australia and New Zealand

“…HMV improves survival and quality of life for selected patients with neuromuscular disease (NMD) [4][5][6] and kyphoscoliosis [7,8] and improves blood gas abnormalities and quality of life for obesity hypoventilation syndrome (OHS) [9][10][11] and cystic fibrosis [12,13]. However, the role in chronic obstructive pulmonary disease (COPD) remains controversial [14][15][16], with a recent Australian randomised controlled trial demonstrating improved survival but decreased quality of life [17], and others using a high-intensity approach finding treatment to be more effective and well tolerated [18].…”