Standardized approach to outpatient clinic visits for patients on long-term non-invasive ventilation with obesity hypoventilation syndrome

BACKGROUND: Long-term non-invasive ventilation (NIV) has a positive effect on symptom reduction, sleep related breathing problems and hypercapnia in obesity hypoventilation syndrome (OHS). After NIV has been established in an inpatient setting, regular inpatient control visits occur. It is unclear whether outpatient control visits are feasible and reduce costs, patient burden and workload on the health care system. Predefined stability criteria may help to identify patients for safe outpatient care in NIV patients with OHS. The aim of this study was to investigate an outpatient setting for NIV follow-up with predefined criteria for stability and hospitalization in patients with OHS.METHODS: Retrospective analysis of patients undergoing regular visits for long-term NIV therapy in an outpatient setting located within a hospital based respiratory care unit.RESULTS: One hundred fifty-nine outpatient visits (49 patients) were analyzed. In 131 cases (82.4%), hospital admission was not necessary following the outpatient visit according to the predefined stability criteria. In 21 cases (13.2%), hospital admission was required; in 7 cases (4.4%) no follow-up visit was planned. Out of the 21 hospitalizations, 5 (23.8%) were prompt admissions and 16 (76.2%) were planned.CONCLUSIONS: Outpatient control of OHS patients with long-term NIV is a feasible alternative. Unstable patients can be identified and admitted, according to predefined stability criteria. These may account for less than 20%.