Home mechanical ventilation. Indications and outcome

Home mechanical ventilation (HMV) is a well-established treatment option for chronic ventilatory failure. The following conditions must be fulfilled for HMV to be indicated: 1) symptoms of chronic ventilatory failure such as dyspnea, morning headache, edema, or symptoms of sleep-disordered breathing, 2) evidence of an underlying disorder that may result in chronic ventilatory failure, such as chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome, restrictive thoracic disorders, or neuromuscular disorders, and 3) evidence of chronic ventilatory failure with specific criteria for different groups of patients. HMV is suggested to improve several outcome parameters, including blood gases, sleep quality, physical capacity, and pulmonary hemodynamics. More important, HMV substantially improves survival, particularly in patients with restrictive diseases. However, in COPD patients, this is still debated. Quality of life has also been shown to improve following commencement of HMV; studies using modern assessment tools have established substantial and enduring quality-of-life benefits in all disease categories.