MANAGEMENT OF CHRONIC RESPIRATORY-FAILURE - INTEREST OF LONG-TERM RESPIRATORY ASSISTANCE AT HOME

Chronic respiratory failure represents an important problem of public health if we consider the potential high number of patients needing to be treated and the expenses linked to a complex treatment having to b e applied at home, Progress of knowledge about chronic respiratory fai lure conducted in the early' 80 to the publication of the BMRC and NOT T studies where long-term oxygentherapy was demonstrated to be efficie nt in severe hypoxic patients with chronic obstructive pulmonary disea se, reducing need for hospitalisation for acute respiratory failure an d thus improving quality of life. In the early '80, several retrospect ive studies showed the interest of mechanical ventilation in the manag ement of chronic respiratory failure secondary to restrictive defects mainly due to chest wall deformities, neuromuscular diseases and tuber culous sequelae. Tracheostomy was initially used as a connection mode to the respirator, the technological progress obtained with the treatm ent of sleep apnea syndrome with nasal continuous positive airway pres sure made convenient masks available, which were in turn used with suc cess to Ventilate ''non invasively'' patients with restrictive defects at horne as well as in acute respiratory failure Nowadays, chronic re spiratory failure is largely managed at home with the help of respirat ory assistance organizations which manage in France through the public ANTADIR network more than 50 000 patients.