Temporal trends in the initiation of domiciliary non-invasive ventilation (NIV)

Introduction: The application of domiciliary NIV is expanding globally. We have previously analysed the proportion of patients who have required elective set up of NIV based on surveillance of “at risk” groups, compared to those who require set up of NIV due to admission to hospital with acute hypercapnic respiratory failure (post-acute). As the service and awareness of the risk factors for T2RF have expanded, we hypothesised that there would be increased surveillance of the at risk population and a resultant increase in the proportion of elective NIV set ups and set out to assess the changes in the modes of initiation of domiciliary NIV in two different 12-month periods. Methods: Birmingham Heartlands Hospital in the West Midlands is one of the largest acute hospitals in the UK. An NIV service was started in 2004 which now supports over 500 outpatients with domiciliary NIV, and also monitors 400 under surveillance for T2RF in “ at risk” populations. Using the internal NIV registry data, we analysed the number and modes of initiation of domiciliary NIV set ups over two periods - Period 1: April 2011-March 2012, Period 2: April 2016-March 2017. Results: In period 1 there were a total of 39 domiciliary NIV set ups, 20 were post-acute (51.3%) and 19(48.7%) were elective. In period 2 there were a total of 26 set ups with the proportion of elective set ups higher at 16(61.5%). Conclusion: Our results demonstrate that there was an increased rate of elective set ups in period 2, accounted for by increased surveillance of the "at risk" population. As demonstrated previously, the proportion of elective set ups ("elective set up" rate) can be tested as a quality/maturity metric of a domiciliary NIV service.