Valko Luca, Baglyas Szabolcs, Gyarmathy V Anna, Gal Janos, Lorx Andras
Department of Anesthesiology and Intensive Therapy, Semmelweis University, Ulloi ut 78/B, Budapest, 1082, Hungary.
EpiConsult, Dover, DE, USA.
BMC Pulm Med. 2020 Aug 17;20(1):221. doi: 10.1186/s12890-020-01262-z.
It has been shown that home mechanical ventilation improves quality of life, but it has not been widely studied which particular patient groups benefit the most from starting this type of therapy. The purpose of this prospective observational study was to evaluate quality of life change patterns 6 months after initiation of home mechanical ventilation in patients suffering from chronic respiratory failure using patient reported outcomes.
We enrolled 74 chronic respiratory failure patients starting invasive or noninvasive home mechanical ventilation through the Semmelweis University Home Mechanical Ventilation Program. Quality of life was evaluated at baseline and at 6 months after initiation of home mechanical ventilation using the Severe Respiratory Insufficiency Questionnaire.
Overall quality of life showed 10.5% improvement 6 months after initiation of home mechanical ventilation (p < 0.001). The greatest improvement was observed in Respiratory complaint (20.4%, p = 0.015), Sleep and attendant symptoms (19.3%, p < 0.001), and Anxiety related subscales (14.4%, p < 0.001). Interface (invasive versus noninvasive ventilation) was not associated with improvement in quality of life (p = 0.660). Severely impaired patients showed the greatest improvement (CC = -0.328, p < 0.001). Initial diagnosis contributed to the observed change (p = 0.025), with chronic obstructive pulmonary disease and obesity hypoventilation syndrome patients showing the greatest improvement, while amyotrophic lateral sclerosis patients showed no improvement in quality of life. We found that patients who were started on long term ventilation in an acute setting, required oxygen supplementation and had low baseline quality of life, showed the most improvement during the six-month study period.
Our study highlights the profound effect of home mechanical ventilation on quality of life in chronic respiratory failure patients that is indifferent of ventilation interface but is dependent on initial diagnosis and some baseline characteristics, like acute initiation, oxygen supplementation need and baseline quality of life.
This study was approved by and registered at the ethics committee of Semmelweis University (SE TUKEB 251/2017; 20th of December, 2017).
已有研究表明家庭机械通气可改善生活质量，但尚未广泛研究哪些特定患者群体从开始这种治疗中获益最大。这项前瞻性观察性研究的目的是使用患者报告的结果评估慢性呼吸衰竭患者开始家庭机械通气6个月后的生活质量变化模式。
我们通过塞梅尔维斯大学家庭机械通气项目招募了74例开始有创或无创家庭机械通气的慢性呼吸衰竭患者。在基线时以及开始家庭机械通气6个月后，使用严重呼吸功能不全问卷评估生活质量。
开始家庭机械通气6个月后，总体生活质量提高了10.5%（p < 0.001）。在呼吸症状（20.4%，p = 0.015）、睡眠及伴随症状（19.3%，p < 0.001）和焦虑相关子量表（14.4%，p < 0.001）方面观察到最大改善。通气方式（有创与无创通气）与生活质量改善无关（p = 0.660）。严重受损患者改善最大（CC = -0.328，p < 0.001）。初始诊断对观察到的变化有影响（p = 0.025），慢性阻塞性肺疾病和肥胖低通气综合征患者改善最大，而肌萎缩侧索硬化症患者生活质量无改善。我们发现，在急性情况下开始长期通气、需要补充氧气且基线生活质量较低的患者，在六个月的研究期间改善最为明显。
我们的研究强调了家庭机械通气对慢性呼吸衰竭患者生活质量的深远影响，这种影响与通气方式无关，但取决于初始诊断和一些基线特征，如急性开始、是否需要补充氧气以及基线生活质量。
本研究经塞梅尔维斯大学伦理委员会批准并注册（SE TUKEB 251/2017；2017年12月20日）。
