Home mechanical ventilation for stable COPD in GOLD 2017: What are we ventilating?

Abstract

Home mechanical ventilation (HMV) is an increasingly common intervention and is initiated for a range of pathological processes. To date, the most relevant conditions in which HMV has successfully been applied are restrictive respiratory failure, including thoracic wall and neuromuscular diseases, and obesity-related respiratory failure. A recent study in obesity hypoventilation syndrome compared HMV and continuous positive airway pressure therapy with a control group managed with lifestyle modification alone over 2 months. Arterial carbon dioxide partial pressure (PaCO2) improved in all groups, but the group receiving HMV presented better improvement than the control group. However, HMV was not significantly superior to continuous positive airway pressure therapy.1 For neuromuscular diseases, specifically in amyotrophic lateral sclerosis, the landmark trial by Bourke et al.2 demonstrating the benefit of HMV on survival in patients without severe bulbar dysfunction has established the therapy as gold standard in these patients who develop chronic respiratory failure. Notably, due to the poor tolerance of HMV in patients with poor bulbar function leading to treatment failure, there has been interest in alternative methods of managing respiratory failure in these patients.