Home mechanical ventilation – an observational study from a tertiary referral centre

<bold>Introduction:</bold> Home mechanical ventilation (HMV) in hypercapnic respiratory failure (HRF) is increasingly used in patients with obesity-related respiratory failure (ORRF), obstructive airway disease (OAD), neuromuscular disease (NMD), chest wall disease (CWD), and sleep-disordered breathing (SDB). <bold>Aims and Objectives:</bold> To provide epidemiological and stratified survival data on HMV. <bold>Methods:</bold> We retrospectively analysed patients with chronic HRF or sleep hypoventilation treated with HMV in the last two decades at the University Hospital Zurich, Switzerland. Kaplan Meier survival analysis was performed for different disease groups. <bold>Results:</bold> 486 patients (26% with myopathy or slowly progressive NMD, 21% with ORRF, 18% with OAD, 14% with SDB, 8% other, 7% with amyotrophic lateral sclerosis (ALS), 6% with CWD) were initiated on HMV. Prescription rate increased and disease group distribution changed over time. Except for myopathies and ALS, the mean group BMI was in the overweight or obese range and all except OAD had moderate or severe sleep apnoea (apnoea-hypopnoea-index>15/h). 206 (42%) were deceased. Median survival on HMV was longest in CWD (219 months) and myopathy (189 months) followed by SDB (123 months) and ORRF (115 months). Median survival was shorter in OAD (29 months) and ALS (19 months) (figure). <bold>Conclusions:</bold> Survival on HMV varies widely, with median of >15 years in CWD and myopathy and circa 2.5 and 1.5 years in COPD and ALS.