Chatwin Michelle, Nickol Annabel H, Morrell Mary J, Polkey Michael I, Simonds Anita K
Sleep and Ventilation Unit, Academic and Clinical Department of Sleep and Breathing, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
Respir Med. 2008 Nov;102(11):1528-35. doi: 10.1016/j.rmed.2008.07.019. Epub 2008 Sep 7.
Long-term home mechanical ventilation (HMV) is usually initiated in hospital. Admission to hospital has resource implications and may not be reimbursable in some healthcare systems.
Twenty-eight stable neuromuscular and chest wall disease patients with nocturnal hypoventilation (transcutaneous carbon dioxide (TcCO(2) >6.5 kPa), were randomised to start HMV either as an outpatient (n=14, age range 12-62 years) or inpatient (n=14, age range 14-73 years). We compared effects of HMV on nocturnal and diurnal arterial blood gas tensions, ventilator compliance, healthcare professional (HCP) contact time, and time in hospital.
Improvements in nocturnal arterial oxygen saturation (SaO(2)) and daytime PaO(2) were equivalent in both groups. Peak nocturnal TcCO(2), improved in both groups; % time TcCO(2) >6.5 kPa fell in the inpatient group and daytime PaCO(2) decreased significantly (p<0.05) in the outpatient group. The mean (SD) inpatient stay was 3.8 (1.0) days, and the outpatient attendance sessions 1.2 (0.4). HCP contact time including telephone calls was: inpatient 177 (99) min; outpatient 188 (60) min (p=not significant); 2 month ventilator compliance was: inpatient 4.32 (7); outpatient 3.92 (8) (p=not significant) hours per night.
Outpatient initiation of HMV is feasible with equivalent outcome in the outpatient and the inpatient groups.
长期家庭机械通气（HMV）通常在医院开始实施。住院会带来资源方面的影响，并且在某些医疗系统中可能无法报销。
28例患有夜间通气不足（经皮二氧化碳分压（TcCO₂）>6.5 kPa）的稳定的神经肌肉和胸壁疾病患者，被随机分为门诊开始HMV组（n = 14，年龄范围12 - 62岁）或住院开始HMV组（n = 14，年龄范围14 - 73岁）。我们比较了HMV对夜间和日间动脉血气张力、通气机顺应性、医护人员（HCP）接触时间以及住院时间的影响。
两组夜间动脉血氧饱和度（SaO₂）和日间动脉血氧分压（PaO₂）的改善情况相当。两组夜间TcCO₂峰值均有所改善；住院组TcCO₂>6.5 kPa的时间百分比下降，门诊组日间动脉血二氧化碳分压（PaCO₂）显著降低（p<0.05）。住院平均（标准差）住院时间为3.8（1.0）天，门诊就诊次数为1.2（0.4）次。包括电话在内的HCP接触时间为：住院组177（99）分钟；门诊组188（60）分钟（p无显著差异）；2个月的通气机顺应性为：住院组每晚4.32（7）小时；门诊组每晚3.92（8）小时（p无显著差异）。
门诊开始HMV是可行的，门诊组和住院组的结果相当。
