Hospital Discharge Planning for Patients Requiring NIMV Support at Home

Abstract

The most common indication for hospital use of noninvasive mechanical ventilation (NIMV) was to threat to exacerbations of chronic type two respiratory failure. This indication is supported by numerous publications and therefore is endorsed by the European Respiratory Society (ERS) guideline as the strongest indication (Rochwerg et al., Eur Respir J 50(2):1602426, 2017). It has to be underlined that revealing acute conditions is not the end of medical problem causing patients increased risk, but mostly a chronic condition, which leads to gradual deterioration and disability. Most patients with chronic respiratory failure are subject to frequent readmissions and/or prolonged hospital stay. The readmission risk is especially high when the patient is discharged too fast (before he/she is clinically stabile—this generates short-term increased readmission risk), but also when the patient is discharged too late (this facilitates contamination with multidrug-resistant pathogens and secondary risk of hospital acquired infections) (Toledo et al., BMJ Open 8(3):e020243, 2018). In numerous cases, the clinical worsening may be important for several weeks after acute exacerbation. Those are known to be responsible for increased death risk, hospital readmissions, and quality-of-life impairment. This is especially important for high-risk patient requiring NIMV during acute episode of respiratory failure but previously not treated with chronic NIMV. The chapter describes most common clinical situations. The given descriptions are based on most important clinical scenarios and will not describe legal issues, which may be different in distinct countries and are frequently due to rapid changes not necessarily related to clinical indications.