The major advantage of NPPV is that it can be applied at home, combining greater potential for psychosocial development and family function, at lesser cost. The use of home NPPV requires appropriate diagnostic procedures, appropriate titration of the ventilator, cooperative and educated families and a careful, well-organised follow-up. Prior to discharge, the patient’s respiratory status should be stable on the actual ventilator and circuit the child will use at home, at least for several days. Settings on a home ventilator do not provide the same ventilation in the child as the same settings on a hospital ventilator, and the efficacy of home equipment must be evaluated in each child prior to discharge. Once the child is at home, and as the child grows, ventilator settings must be evaluated to ensure adequate gas exchange on a regular basis. Although the optimal frequency for these evaluations has not been determined, these evaluations should be performed more frequently in infants and small children because of their rapid growth. Sleep evaluations are recommended as a diagnostic tool before the initiating of NPPV, then as a control test of the efficacy of NPPV before discharge with the ventilator, and as a surveillance test during an overnight hospital admission during follow-up (Paiva et al. 2009). Careful extrapolation should be made from a sleep evaluation performed during daytime naps because this does not always reflect what happens during the night. Routine and emergency service must be available. Providers/home care equipment technicians and nurses should visit the patient at home at least every month to perform preventive maintenance and check of the interface and the ventilator. Evaluation of compliance should be systematically checked by counters on the equipment determining the amount of time the ventilator is effectively used and not only turned on.

Patients requiring home NPPV may need other supportive therapies. Cough-assisted techniques, by means of the mechanical insufflator-exsufflator, for example, are recommended in every patient with neuromuscular disease who is started on NPPV. The mechanical insufflator-exsufflator is very efficient and well-tolerated in helping the patient clear his respiratory secretions (Fauroux et al. 2008b). Oxygen therapy at home must be justified on the basis of an individual-based medical necessity, as determined by appropriate physiological monitoring, with pulse oximetry monitoring during periods of sleep, wakefulness, feeding and physical activity and arterial blood gases. CO₂ levels should be minimised first by ventilator use before considering oxygen therapy, especially for patients with neuromuscular disorders and obstructive sleep apnoea. It is important to remember that supplemental oxygen is not a replacement for assisted ventilation in patients who hypoventilate.