Murphy - Figure 60

Conclusion

FIG. 60: In conclusion, what the results of the HOT-HMV trial[1] are compared with to previous data so that the correct patient population is identified, meaning patients who not only had acute respiratory failure requiring NIV, but also have demonstrable chronic respiratory failure (which is a clearly treatable characteristic), this allowed the addition of home ventilation to confer a significant improvement in admission-free survival over the following 12 months.

It is clear that this admission-free survival is not at the expense of increased levels of exacerbations in the community, but is disease modifying, with a reduction in exacerbation rate as the underlying driver for the change in admission status. What is also clear is that this intervention allows a possible treatment for patients in whom prognosis and outlook is poor, and, therefore, we should be practically screening patients who require acute NIV in the recovery period to identify those with chronic respiratory failure.

Earlier work and these current data also suggest that home ventilation has to be titrated to overnight objective measures of hypoventilation to ensure improvement not only of nocturnal respiratory changes, but also leading to an impact on daytime respiratory failure. Physicians can also to be clear with patients that there is no negative effect of home ventilation on their quality of life, but that there may well be some, at least early, improvement in QOL.

Murphy P. Chest 2017:00.

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