Two-way remote monitoring allows effective and realistic provision of home-NIV to COPD patients with persistent hypercapnia.

McDowell, G.; Sumowski, M.; Toellner, H.; Karok, S.; O'Dwyer, C.; Hornsby, J.; Lowe, D.; Carlin, C.

Background Outcomes for chronic obstructive pulmonary disease (COPD) patients with persistent hypercapnic respiratory failure are improved by long-term home non-invasive ventilation (NIV). Provision of home-NIV presents clinical and service challenges. The aim of this study was to assess outcomes of home-NIV in hypercapnic COPD patients managed remotely. Methods Retrospective analysis of a dataset of 46 COPD patients with persistent hypercapnic respiratory failure who commenced home-NIV managed by two-way remote monitoring (Lumis, AirView, ResMed) between February 2017 and January 2018. The primary outcome of this study was time to readmission or death at 12 months in patients receiving home-NIV versus a retrospectively identified control cohort of 27 patients with hypercapnic COPD who had not been referred for home-NIV. Results The median time to readmission or death was significantly prolonged in patients who commenced home-NIV (median 160 days, 95% CI 69.38-250.63) versus the control cohort (66 days, 95% CI 21.9-110.1; p<0.01). Average time to hospital readmission was 221 days (95% CI, 47.77-394.23) and 70 days (95% CI, 55.31-84.69; p<0.05), respectively. Median decrease in bicarbonate level of 4.9mmol/L (p<0.0151) and daytime PCO2 2.2kPa (p<0.032) demonstrate efficacy of home-NIV. A median reduction of 14 occupied bed days per annum versus previous year prior to NIV was observed per patient who continued home-NIV throughout the study period (N=32). Conclusion These findings confirm the benefits of home-NIV in clinical practice and support the use of two-way remote monitoring as a feasible solution to managing the delivery of home-NIV for COPD patients with persistent hypercapnia.