[Instrumental management of chronic respiratory insufficiency: contribution of long-term therapeutic assistance at home].

Chronic respiratory failure represents an important problem of public health if we consider the potential high number of patients needing to be treated and the expenses linked to a complex treatment having to be applied at home. Progress of knowledge about chronic respiratory failure conducted in the early' 80 to the publication of the BMRC and NOTT studies where long-term oxygen therapy was demonstrated to be efficient in severe hypoxic patients with chronic obstructive pulmonary disease, reducing need for hospitalisation for acute respiratory failure and thus improving quality of life. In the early '80, several retrospective studies showed the interest of mechanical ventilation in the management of chronic respiratory failure secondary to restrictive defects mainly due to chest wall deformities, neuromuscular diseases and tuberculous sequelae. Tracheostomy was initially used as a connection mode to the respiratory; the technological progress obtained with the treatment of sleep apnea syndrome with nasal continuous positive airway pressure made convenient masks available, which were in turn used with success to ventilate "non invasively" patients with restrictive defects at home as well as in acute respiratory failure. Nowadays, chronic respiratory failure is largely managed at home with the help of respiratory assistance organizations, which manage in France through the public ANTADIR network more than 50,000 patients.