Impact of outpatient adaptation to home mechanical ventilation on health-related quality of life in patients with chronic obstructive pulmonary disease: the OutVent study

Abstract

Home mechanical ventilation (HMV) is indicated in patients with severe hypercapnic chronic obstructive pulmonary disease (COPD). Initiation of HMV commonly occurs during an inpatient period, but there has been increasing interest for outpatient adaptation.This study aimed to evaluate the outpatient initiation and adaptation of HMV and its impact on health-related quality of life (HRQoL) in patients with severe COPD.A single group pretest-posttest study was conducted in an Outpatient Ventilation Clinic of a tertiary hospital in Portugal. Severe COPD patients with symptoms of chronic respiratory failure with daytime pCO2≥50 mmHg in stable condition or persistent hypercapnia ≥53 mmHg >14 days following an exacerbation with mechanical ventilation were included. After 3-months of HMV, patients completed the Severe Respiratory Insufficiency (SRI), the S3-non-invasive ventilation (S3-NIV) and a patient-experience questionnaire.Fifty-three patients (73.6% male, median 71 [p25-p75 61–77] years.), with a median FEV1of 35 [29–40] % and a median baseline pCO2of 53.5 [51.9–56.5] mmHg completed the study. At 3 months patients had a median HMV usage of 6.5 h and decreased their pCO2by 6.0 mmHg. After 3 months, there was a significant improvement in the SRI Summary Scale (+5.7), above the minimal clinically import difference of 5. Patients who used HMV more than 5 h had higher S3-NIV total score (6.8versus5.7, p=0.04) and S3-NIV Sleep & NIV related side effects subscore (7.1versus5.7, p=0.03).Our findings might indicate that outpatient initiation and adaptation of HMV has a positive impact in short-term HRQoL in patients with COPD and that that this approach is perceived as a positive experience by the patients.