Where is the best location to start noninvasive positive pressure ventilation (NPPV)?
Generally, NPPV is started in the home by a respiratory therapist from the home health care agency or durable medical equipment (DME) provider, as ordered by the physician (who is not present). However, home health respiratory therapists have limited time, and the home health care agency does not receive reimbursement for the time needed. The therapist usually cannot demonstrate the whole range of equipment and interface options available. Followup is needed repeatedly in the first months to ensure that the equipment and interfaces are comfortable and working properly to achieve optimal benefit. The use of NPPV can also be initiated as part of hospital discharge. where there should be more time to do it properly. However, many pulmonary critical care physicians are highly ICU-focused, and they and the respiratory therapy staff may not have the experience and interest needed to get optimal results. When possible, the best approach may be for the individual to visit the home MV unit of a
