Non-invasive positive pressure ventilation in the home setting

The complexity of patients living longer with multiple comorbidities means that more patients are requiring long-term non-invasive positive pressure ventilation (NPPV), both in hospital and at home. NPPV reverses or safely maintains the arterial acid-base balance associated with hypercapnic or type 2 respiratory failure. In the home environment, the main reasons for NPPV therapy are to preserve quality of life and maintain life expectancy, depending on the condition that is being treated (Simonds, 2012; Gale et al, 2015). For some patients, this therapy is used to reduce symptoms associated with more severe disease in later stages of life, such as breathlessness, sleep disturbance and daytime sleepiness. Although most patients commenced on NPPV will have been reviewed and assessed by a specialist team, having an understanding of the therapy and the challenges it presents can significantly help support patient compliance and has the potential to reduce the problems that patients experience. New data is emerging around the use of this therapy, especially for patients with chronic obstructive pulmonary disease (COPD), who have shown improved admission-free survival rates with NPPV (Criner et al, 2018). Thus, the potential of the application of NPPV in the home environment is increasing. With this, nurses and other healthcare practitioners may be asked to support patients receiving NPPV in the home environment, including the application of masks and support with equipment. Nurses having specialist knowledge and understanding of NPPV within the home environment will promote patient compliance and reduce hospital admissions and complications associated with NPPV therapy.