Introduction
It is recommended that non-invasive ventilation (NIV) should be adapted and
initiated during hospitalization, however, this can be carried out in an outpatient
clinic or day-hospital as well, with similar results. The aim was to compare the
outcomes of home-based NIV adaptation with in-hospital initiation, measured by
the level of arterial carbon dioxide pressure 3 months after NIV and subsequent
exacerbations at 1-year of follow up.

Material and methods.
Case-control study of patients admitted to a program of home hospitalization for
NIV initiation, from November 2020 to October 2022. Adaptation was carried out
by an expert pulmonologist, monitored with built-in software reading, blood gas
analyses and in some cases polygraphy under NIV. Controls were selected
from clinical registries with a 1:1 ratio, based on age, sex and chronic
respiratory failure etiology. Outcome variables were arterial carbon dioxide
pressure (PaCO 2 ) 3 months after NIV and subsequent exacerbations at 1-year
of follow up.

Results
A total of 38 patients were included (19 cases, 19 controls), their mean age was
of 67.1 ± 13.3 years, 22 were males (58%). Sixteen patients had neuromuscular
diseases (40%), 12 of them with amyotrophic lateral sclerosis. No differences
were found in terms of days of NIV adaptation, post-NIV PaCO 2 or acute-on-
chronic respiratory failures. Outcomes are summarized in Table 1. PaCO 2
evolution pre and post-NIV adaptation is presented in Figure 1.

Conclusions
Home adaptation was feasible and effective in terms of sustained reduction of
hypercapnia and number of subsequent exacerbations compared to initiation of
mechanical ventilation in the hospital setting.