P194 Inpatient adjustment of sub-optimal home mechanical ventilation (HMV) – an effective use of resources?. (12th November 2015)

• Record Type: Journal Article
• Authors: Frost, F; Al-Hakim, B; Wordingham-Baker, S; Ford, V; Ashcroft, H; Ward, K; Parker, R; Chakrabarti, B; Angus, R; Duffy, N
• Is Part Of: Thorax. Volume 70(2015)Supplement 3
• Page Start: A174
• Page End: A174
• Publication Date: 2015-11-12
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2015-207770.331
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Introduction: HMV can be initiated and monitored as either inpatient or outpatient. There is little evidence for best practice in this field and inpatient ventilation beds are a scarce resource. We evaluated patients, with sub-optimal HMV, admitted to our tertiary unit for adjustments to consider whether these admissions were successful, and hence an effective use of resources. Methods: Patients were identified from our ventilation unit's database. Notes, oximetry and ventilator download from pre-admission, pre-discharge and post-discharge were retrospectively analysed. Results: In a 6-month period (June–December 2013) 30 patients were admitted to our unit for adjustments of HMV. 43% were female. Obesity related sleep disorder formed the majority of underlying conditions (53%), with musculoskeletal deformities (20%) and neuromuscular conditions (10%) also frequently seen. Median length of stay was 2 days. HMV was discontinued during admission in 2 cases in line with patient wishes. 19 (63%) were deemed to have had successful admissions, defined as normalisation of at least one abnormal ventilation parameter (pCO2 >6.0, desaturations >14/hr, time below 90% of >30 min, mean saturations of <88%, usage >6 hrs, leak <50 L/min). Of the 19 successful admissions, 6 showed sustained improvement post-discharge. 11 (37%) admissions were deemed unsuccessful, poor baseline usage and missed outpatient appointments were observed in this group. Noteworthy improvements were made to oximetry parameters during admission, although not all of these were maintained post-discharge (Table 1 ). Ventilator leak and usage information was available for 22 (73%) patients. Excess leak (50 >L/min) was seen in 10 patients pre-admission, only 1 patient had excess leak post-discharge. Pre-admission usage of <2 h/night was seen in 6 patients, only 1 showed sustained improvement in usage. 8 patients were admitted with usage of 2– 4 h, 4 improved post discharge usage to >6 h and only 1 showed deterioration in usage. Conclusion: Admitting patients for adjustments to HMV can improve ventilation parameters yet only some of these improvements are maintained after discharge. There appears to be a subset of patients who do not benefit from inpatient admissions, particularly patients with poor baseline usage. We suggest careful selection of patients to ensure effective use of limited resources.