A simple model for home initiation of Long-term non-invasive ventilation for treatment of respiratory failure in COPD – a Danish clinical experience

Introduction: Home initiation of long-term non-invasive ventilation (LT-NIV) for patients with chronic respiratory failure of COPD has been shown to be as effective and more cost-efficient as initiation during admission. However, the use of transcutaneous carbon dioxide (CO2) measurement at home is time consuming, complicated, and expensive. Consequently, we developed a simple model for home initiation without transcutaneous CO2 measurement.
Aim: To present a strategy for simple home initiation without using transcutaneous CO2 measurement.

Methods: A retrospective cohort study including all patients referred to initiated on LT-NIV with arterial CO2 (PaCO2) > 7 kPa from 1st of October 2022 to 31st August 2023 at the section of respiratory medicine, department of medicine at Herlev-Gentofte Hospital, Denmark.

Results: In all 21 patients were initiated, and 2 (9.5%) needed admission to achieve adherence to LT-NIV and PaCO2 reduction. Reasons for failing home initiation and needing admission were failure to comply, very low treatment adherence, and no significant PaCO2 reduction despite 3 to 4 attempts at out-patient visits.

Conclusion: This model for outpatient LT NIV initiation in COPD is simple and useful, with very few failures that required initiation during hospital admission.