Indications and evidence for domiciliary noninvasive ventilation

Area of Science:

• Respiratory Medicine
• Sleep Medicine
• Critical Care

Background:

• Home noninvasive ventilation (HNIV) use is increasing globally.
• HNIV demonstrates improved patient outcomes in chronic hypercapnic respiratory failure.
• Obesity hypoventilation syndrome (OHS) is a primary indication for HNIV, complicating management in patients with COPD and obstructive sleep apnea hypoventilation syndromes (OSAHS).

Purpose of the Study:

• To review the evidence for HNIV in COPD, OHS, neuromuscular disease (NMD), and chest wall disease (CWD).
• To highlight commonly used HNIV modes.
• To identify knowledge gaps in HNIV optimization and application.

Main Methods:

• Literature review of evidence for common HNIV indications.
• Discussion of prevalent HNIV modes.
• Analysis of current research gaps and future directions.

Main Results:

• HNIV is effective for various respiratory conditions, including COPD, OHS, NMD, and CWD.
• Specific HNIV modes are utilized depending on the underlying disease.
• Optimal HNIV settings, particularly inspiratory pressures for OHS and COPD, require further investigation.

Conclusions:

• Active screening for nocturnal hypoventilation in OHS and COPD may facilitate earlier HNIV initiation.
• More research is needed to determine the best HNIV modalities and timing for different patient phenotypes.
• Clinical trials should focus on patient-related outcomes and cost-effectiveness in real-world populations.