Home mechanical ventilation: who cares about how patients die?

H ome mechanical ventilation (HMV) is increasingly being used to treat chronic hypercapnic respiratory failure arising from different aetiologies, such as restrictive thoracic disorders, neuromuscular disorders (NMD), obesity hypoventilation syndrome and chronic obstructive pulmonary disease (COPD) [1–3]. The prognosis of patients receiving HMV depends on both the type and state of disease upon commencement of HMV, with the worst outcome reported in patients with COPD, as well as those with rapidly progressive NMD such as amyotrophic lateral sclerosis (ALS) [3–6]. However, in contrast, the survival benefits provided by HMV in individuals with restrictive thoracic disorders or stable, slowly progressive NMD are overwhelming [3–6]. Importantly, HMV has also been shown to strongly improve health-related quality of life (HRQoL) in patients with varying disorders including COPD and NMD [7]; this improvement was revealed via the application of the Severe Respiratory Insufficiency Questionnaire [8, 9], an instrument specifically developed and validated for patients with HMV use. In addition, enhancements in HRQoL were also reported in several previous trials that used various instruments to assess HRQoL [3–5]. Thus, HMV has become the treatment of choice for patients with chronic hypercapnic respiratory failure, which is a sign of major progress in medicine.