NIV@Home: a pilot randomized controlled trial of in-home noninvasive ventilation initiation compared to a single-day admission model.

Autor: Sheers NL; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia.; Institute for Breathing and Sleep, Heidelberg, Australia.; The University of Melbourne, Parkville, Australia., Hannan LM; Institute for Breathing and Sleep, Heidelberg, Australia.; The University of Melbourne, Parkville, Australia.; Department of Respiratory Medicine, Northern Health, Epping, Australia., Rautela L; Institute for Breathing and Sleep, Heidelberg, Australia.; Department of Physiotherapy, Austin Health, Heidelberg, Australia, and., Graco M; Institute for Breathing and Sleep, Heidelberg, Australia.; The University of Melbourne, Parkville, Australia., Jones J; Institute for Breathing and Sleep, Heidelberg, Australia.; The University of Melbourne, Parkville, Australia.; Department of Physiotherapy, Austin Health, Heidelberg, Australia, and., Retica S; Department of Physiotherapy, Austin Health, Heidelberg, Australia, and., Saravanan K; Institute for Breathing and Sleep, Heidelberg, Australia., Burgess N; The University of Melbourne, Parkville, Australia.; Department of Physiotherapy, Austin Health, Heidelberg, Australia, and., McGaw R; Department of Physiotherapy, Austin Health, Heidelberg, Australia, and., Donovan A; Department of Physiotherapy, Austin Health, Heidelberg, Australia, and., Clohessy T; Institute for Breathing and Sleep, Heidelberg, Australia.; The University of Melbourne, Parkville, Australia.; Department of Physiotherapy, Austin Health, Heidelberg, Australia, and., Chao C; Institute for Breathing and Sleep, Heidelberg, Australia.; Department of Physiotherapy, Austin Health, Heidelberg, Australia, and., Charles C; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia., Howard ME; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia.; Institute for Breathing and Sleep, Heidelberg, Australia.; The University of Melbourne, Parkville, Australia.; Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia., Berlowitz DJ; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia.; Institute for Breathing and Sleep, Heidelberg, Australia.; The University of Melbourne, Parkville, Australia.; Department of Physiotherapy, Austin Health, Heidelberg, Australia, and.
Jazyk: angličtina
Zdroj: Amyotrophic lateral sclerosis & frontotemporal degeneration [Amyotroph Lateral Scler Frontotemporal Degener] 2024 Oct 21, pp. 1-10. Date of Electronic Publication: 2024 Oct 21.
DOI: 10.1080/21678421.2024.2416668
Abstrakt: Objective : Noninvasive ventilation (NIV) is the primary treatment for respiratory insufficiency in neuromuscular disease. NIV implementation is usually conducted within hospitals; however, in-home implementation with intensive follow-up is an effective alternative. This pilot study aimed to assess model feasibility, acceptability, and NIV usage at 12-weeks after a single visit in-home implementation of NIV with remote monitoring follow-up (NIV@Home) compared to an in-hospital day admission NIV initiation plus planned polysomnography (Usual care). Methods : A single-blinded randomized controlled trial (www.anzctr.org.au ACTRN12620000682943) of adults with neuromuscular disease referred for NIV implementation. Participants were stratified by disease (MND or Other diagnoses) and bulbar symptoms before randomization to NIV@Home or Usual care, with follow-up at 12-weeks. The primary outcome was NIV usage. Secondary outcomes included feasibility, health-related quality of life, symptoms, carer burden, and NIV experience (semi-structured qualitative interviews). Results : Twenty-three participants (MND bulbar = 9, MND non-bulbar = 11, Other = 3) were randomized (NIV@Home = 9). No statistical differences were observed in the percentage of MND participants using NIV for >4 hours/day (NIV@Home = 33% vs. Usual care = 60%, p  = 0.370), average use (NIV@Home = 2.4 [1.5-9.3] vs. 5.3 [1.8-7.0] hours/day, p  = 0.568), or secondary outcomes. In-home NIV implementation was feasible and safe but took more therapist time (NIV@Home = 278 [270-305] vs. 172 [130-200] minutes, p  < 0.001). Participants in the NIV@Home group reported substantial advantages to receiving care in home. Conclusion : In-home NIV implementation is feasible and acceptable to people with MND but requires more therapist time. Larger studies are required to determine whether there are clinically important differences between this model of NIV initiation and a traditional hospital-based model.
Databáze: MEDLINE
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