Update in Noninvasive Home Mechanical Ventilation: A Narrative Review of Indications, Outcomes, and Monitoring

Abstract

Hypercapnic respiratory failure arises due to an imbalance in the load‐capacity‐drive relationship of the respiratory muscle pump, typically arising in patients with chronic obstructive pulmonary disease, obesity‐related respiratory failure, and neuromuscular disease. Patients at risk of developing chronic respiratory failure and those with established disease should be referred to a specialist ventilation unit for evaluation and consideration of home noninvasive ventilation (NIV) initiation. Clinical trials demonstrate that, following careful patient selection, home NIV can improve a range of clinical, patient‐reported, and physiological outcomes. This narrative review provides an overview of the pathophysiology of chronic respiratory failure, evidence‐based applications of home NIV, and monitoring of patients established on home ventilation and describes technological advances in ventilation devices, interfaces, and monitoring to enhance comfort, promote long‐term adherence, and optimise gas exchange.