Complex home assessment of long-term non-invasive ventilation efficacy using transcutaneous monitoring of PCO2 and polygraphy - A feasibility study

Purpose: Home non-invasive ventilation (HNIV) during sleep is a standard treatment for chronic hypercapnic respiratory failure (CHRF). The aim of this study was to evaluate the feasibility of the complex overnight assessment of HNIV in adults performed at home and the efficacy of HNIV after one year of treatment. Methods: Stable patients with CHRF on HNIV for more than 12 months had unattended polygraphy (PG) with transcutaneous monitoring of PCO2 (tcPCO(2)) at home during one night. The recording quality was regarded as excellent when 100% and good if 80-99% of the analysis time was registered. The following efficacy criteria were approved: (1) SpO(2)<90% for <10% of analysis time, (2) increase in PtcCO(2) <= 7.5 mmHg between baseline and average value at night, (3) apnea-hypopnea index (AHI) <= 5/h. Results: Eighteen patients with CHRF (median age 66 [60-74] years, 10 female) were included. The quality of the PG tracings was good to excellent in 16 (89%) patients and the quality of the tcPCO(2) data was good to excellent in 14 (78%) patients. There was no difference in the quality of tcPCO(2) between patients who lived alone and those who lived with family (100 [50-100]% vs. 100 [90-100]% of analysis time, respectively). Only 4 (22%) patients fulfilled all three efficacy criteria. Conclusions: Home-based monitoring using PG and tcPCO(2) is a feasible and adequate tool to assess the efficacy of HNIV. In most of the patients on HNIV for more than 12 months, the treatment was not effective based on the predefined efficacy criteria.