Home Mechanical ventilation in the Netherlands. What is the reason for not starting non-invasive ventilation at home?

Introduction: In the Netherlands, Home Mechanical Ventilation (HMV) is provided by only 4 University hospitals covering the entire country. Recently a national randomised study was started to investigate the effects of initiating HMV at home (HOMERUN study). Every centre included 24 patients with neuromuscular disease or thoracic cage abnormality with an indication to HMV. Patients had to be older than 18 years and a sufficient network to initiate HMV at home was mandatory. Methods: All referred patients who had an indication for starting non-invasive HMV were screened to participate in the Homerun study. If there was no participation, the reasons were noted. Results: Large differences were found between the 4 centres for excluding patients in this trial. The exclusion rate in Rotterdam was significantly higher than in the other 3 centres. (see table) In Rotterdam, insufficiently knowledge of the Dutch language by patients or caregivers was an important reason for excluding. In addition, around 20% of the patients started HMV in an (semi-) acute phase. To the HMV centre in Utrecht primarily patients with an NMD or TCA were referred. Conclusion: These data show that a large group of referred patients are currently not eligible to start HMV at home while the reasons differ between the 4 centres. To achieve the national goal to start HMV at home each centre has to develop its own approach.