The comments on our article published in CHEST, about home mechanical ventilation (HMV), are very refreshing as the results of the study elucidated those same questions by us. However, the main purpose of the study was to assess quality of life (QoL) of patients receiving HMV. The study was retrospective, and the purpose was never to relate QoL with lung mechanics, different modes of mechanical ventilation, or blood gases. Several studies1–3
have shown that QoL is not related to such specific measurable values, but is related instead to the patient’s coping ability. Because treatment with HMV has increased in Sweden, we wanted to see how our patients with different diagnoses perceived their QoL using HMV. We wanted also to elucidate how our patients with chronic respiratory insufficiency were initiated and treated during a period of 20 years. The unique knowledge of our clinic in making individually fitted tracheal cannulas should be kept in mind. These patients were never able to choose one treatment or another, as most of them probably received the tracheostomy as an acute lifesaving treatment, and they feel secure with this. We disagree when you say that we have equated noninvasive ventilation (NIV) only with mask ventilation. The results shows that ventilation by tracheostomy also provides a good QoL. We conclude that the patients treated with both NIV and invasive HMV reported a good QoL.