Initiation of home mechanical ventilation at home in a selectve group of patients with chronic hypercapnic respiratory failure in the Netherlands

INTERVENTION: The proposed intervention to be studied is initiation of HMV at home as compared to in hospital initiation I different settings. Recently a pilot study was performed in Groningen in which the initiation of HMV at home was compared with an in hospital start. We found that initiation of HMV at home in a selected group under strict supervision of a HMV center seemed effective, safe, and probably cost‐effective compared to inpatient initiation. These results need to be duplicated and extrapolated to other models of initiation in the hospital than the Groningen model. We will therefore perform a similar study, in all four existing centers for home mechanical ventilation in the Netherlands.. CONDITION: Ventilation, Neuromuscular diseases, Cost‐effectiveness , Mechanical ventilation, Telemonitoring ; ; PRIMARY OUTCOME: Primary objective:; ; ‐ Daytime arterial carbon dioxide (PaCO2) assessed without oxygen supplementation and ventilatory support while the patient is in sitting position; SECONDARY OUTCOME: Secondary objective: ; ; ‐ Health related quality of life ; ; ‐ Lung function ; ; ‐ Nocturnal transcutaneous carbon dioxide and saturation ; ; ‐ Costs ; INCLUSION CRITERIA: Indication to initiate non‐invasive ventilatory support in patients with a neuromuscular disease or thoracic cage abnormality who suffer from complaints of alveolar hypoventilation (fatigue, headache of dyspnoea) combined with all following elements: ‐ arterial carbon dioxide > 6.0 kPa daytime or arterial or transcutaneous carbon dioxide > 6.0 kPa at night or orthopnea as a result of diaphragm paralysis ‐ Age > 18 years ‐ Existence, of a sufficient network (social or professional) according to the supervising HMV center making initiation of HMV at home possible and safe.