부산대학교 도서관

IntroductionLong-term domiciliary NIV is increasingly used for patients with chronic respiratory failure, typically due to neuro-muscular disease, sleep-disordered breathing/obesity hypoventilation, obstructive lung disease (COPD) and restrictive lung disease. The benefit of domiciliary NIV in patients with neuro-muscular disease is well established, and recent evidence of the prognostic benefit in COPD may lead to increased use of home NIV in this group. Here, we intended to analyse and compare the indications for NIV, patient demographics, mode of NIV initiation (elective or emergency admission) and mortality in a cohort of patients newly-started on NIV over a 9 year period.MethodsA retrospective observational cohort study was performed using data collected between 2007 and 2015 in a single-centre teaching hospital. Patients newly started on domiciliary NIV were screened using electronic patient records and departmental NIV databases. Patients commenced on NIV for chronic respiratory failure were included, whilst cases under 18 years of age and in whom NIV was supplied for other indications (e.g., sputum clearance) were excluded. SPSS was used for analysis.Results311 cases were included, of which there was a slight majority of males (56.3%). 50.2% of patients were diagnosed with a neuro-muscular disorder (mean age of 61.6 years); 35.7% of as sleep-disordered breathing/obesity hypoventilation (mean age 56.4 years), 12.2% as COPD (mean age 62.7 years) and 1.9% of cases were established as restrictive lung disease (mean age 54 years). We found that 76.3% of COPD patients were set up acutely, whereas 73.7% of patients with neuromuscular disorders were established electively on NIV. In total, 58.1% of cases were elective starters; 49.4% patients commenced electively died within 12 months. Regression analysis indicated a significant effect of year on mortality (p=0.002). Chi-square testing showed no association between initiation mode and gender (p=0.405).ConclusionsWe demonstrate that domiciliary NIV use is particular high amongst neuro-muscular patients. Survival of patients on domiciliary NIV has improved in this single centre, and is associated with year of initiation, but mortality at 12 months is unchanged.