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Clinical Investigations: NPPV |

Changing Patterns in Long-term Noninvasive Ventilation*: A 7-Year Prospective Study in the Geneva Lake Area

Jean-Paul Janssens, MD; Sophie Derivaz, MD; Eric Breitenstein, MD; Benoı̂t de Muralt, MD; Jean-William Fitting, MD; Jean-Claude Chevrolet, MD; Thierry Rochat, MD
Author and Funding Information

*From the Pulmonary Division (Drs. Janssens, Breitenstein, and Rochat), the Department of Internal Medicine (Dr. Derivaz), and the Division of Medical Intensive Care (Dr. Chevrolet), Geneva University Hospital, Geneva, Switzerland; the Center for Pulmonary Rehabilitation (Dr. de Muralt), Hôpital de Rolle, Rolle, Vaud, Switzerland; and the Pulmonary Division (Dr. Fitting), Lausanne University Hospital, Lausanne, Switzerland.

Correspondence to: Jean-Paul Janssens, MD, Center Antituberculeux, Hôpital Cantonal Universitaire, 1211 Geneva 4, Switzerland; e-mail: janssens@iprolink.ch



Chest. 2003;123(1):67-79. doi:10.1378/chest.123.1.67
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Study objectives: To describe a 7-year follow-up (1992 to 2000) of patients who were treated by home nasal positive-pressure ventilation (NPPV) for chronic hypercapnic respiratory failure.

Design: Prospective descriptive study.

Setting: Two university hospitals and a pulmonary rehabilitation center.

Patients: Two hundred eleven patients with obstructive pulmonary disorders (58 patients) or restrictive pulmonary disorders (post-tuberculosis, 23 patients; neuromuscular diseases [NM], 28 patients; post-poliomyelitis syndrome, 12 patients; kyphoscoliosis [KYPH], 19 patients; obesity-hypoventilation syndrome [OHS], 71 patients) who were treated by long-term NPPV.

Intervention: Annual, elective, standardized medical evaluations.

Measurements: Pulmonary function tests, arterial blood gas levels, health status, compliance, survival and probability of pursuing NPPV, and hospitalization rates.

Results: Patients with OHS, NM, and KYPH had the highest probability of pursuing NPPV, while patients with COPD had the lowest values. Overall, the compliance rate was high (noncompliance rate, 15%). As of 1994, COPD and OHS became the most frequent indications for NPPV, increasing regularly, while other indications remained stable. The use of pressure-cycled ventilators progressively replaced that of volume-cycled ventilators in most indications. Hospitalization rates decreased in all groups after initiating NPPV, when compared with the year before NPPV, for up to 2 years in COPD patients, and 5 years in non-COPD patients.

Conclusion: Major changes in patient selection for NPPV occurred during the study period with a marked increase in COPD and OHS. The shift toward less expensive pressure-cycled ventilators and the decrease in hospitalizations after initiating NPPV have had positive impacts on the cost-effectiveness of NPPV in patients with chronic respiratory failure.

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