Non-invasive home mechanical ventilation: effectiveness and efficiency of an outpatient initiation protocol compared with the standard in-hospital model.

OBJECTIVE To compare the effectiveness and efficiency of an initiation protocol for non-invasive home mechanical ventilation (NIHMV) carried out at a pulmonary outpatient clinic with the standard in-hospital model. METHODS Prospective, observational study. POPULATION 16 patients divided into two groups: (A) outpatient protocol (n=9); and (B) standard in-hospital initiation with an elective admission (n=7). INSTRUMENTATION at baseline condition and treatment starting, arterial blood gases and nocturnal pulse-oximetry were performed. At the end of follow-up, arterial blood gases and patient compliance (ventilator's built-in counter) was determined. Efficiency was evaluated by calculating cost savings per ventilated patient for the financier and accumulated days of hospitalization saved. RESULTS No differences in baseline conditions were observed. Ventilation was effective in the two groups: a significant decrease in PaCO(2) and an increase in mean nocturnal oxygen saturation were observed after initiating ventilation. (Group A: PaCO(2):42.9+/-1.5; SpO(2):91.9+/-1.9; Group B:PaCO(2):44.3+/-6; SpO(2):91.9+/-2.7). At three months the effectiveness of ventilation and the number of hours of ventilation was equivalent in all groups. The new model cut costs for the health care financier by 50%. The outpatient sessions saved 63 days of hospitalization. CONCLUSIONS (1) Outpatient initiation is an effective and efficient alternative to the traditional in-hospital method for NIHMV. (2) The outpatient protocol represents a substantial saving for the financier.

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