CHEST Guidelines-Home-Mechanical-Ventilation

Home-Mechanical-Ventilation_chest

Pdf Summary

Home mechanical ventilation (HMV) is increasingly becoming a favored treatment for chronic hypercapnic respiratory failure, administered either noninvasively or through tracheostomy. Historically effective for conditions like neuromuscular diseases, thoracic deformities, and obesity-hypoventilation syndrome, recent studies demonstrate its benefits for COPD patients, particularly when using high-intensity HMV. Landmark trials have shown improvements in survival rates and reduced hospitalizations for stable and acute respiratory failure patients.<br /><br />A notable study by Cantero et al. highlighted a significant rise in HMV prevalence, urging an understanding of patients' phenotypic differences affecting treatment results. Yet, the prevalence of neuromuscular disease patients on HMV remains low, influenced heavily by regional medical practices and physician beliefs about quality of life impacts.<br /><br />Most HMV initiations occur in hospitals, often following acute respiratory events, suggesting a need for proactive monitoring to enable earlier interventions. Emerging studies show that initiating HMV at home, particularly for COPD and neuromuscular disorder patients, is cost-effective and can be as effective as hospital-based starts, suggesting a promising alternative for healthcare systems.<br /><br />Additionally, the paper emphasizes characterizing COPD patients accurately, as obesity and concomitant OSA in COPD patients might require different treatment strategies compared to lean COPD patients. The primary focus of HMV in COPD is reducing CO2 levels, though this might not encompass all necessary treatment goals, highlighting the need for further research.<br /><br />Overall, the article underscores the crucial ongoing growth of HMV usage, especially among COPD patients. It points out the need for comprehensive research to better characterize patient subgroups and develop optimal treatment protocols while exploring cost-effective care alternatives, like at-home HMV initiation.

Keywords

home mechanical ventilation

chronic hypercapnic respiratory failure

COPD

neuromuscular diseases

tracheostomy

high-intensity HMV

Cantero study

hospitalization reduction

cost-effective care

patient phenotypes