Home mechanical ventilation

Definition and goals ofhome mechanical ventilation Born during the polio epidemics of 50 years ago, home mechanical ventilation has evolved towards two distinct concepts-a life support system for patients without respiratory independence (high cervical spinal cord injury, end stage neuromuscular disease, or chronic obstructive pulmonary disease), and elective therapy for patients with progressive chronic respiratory insufficiency (mostly restrictive parietal or neuromuscular insufficiency) which prevents acute respiratory failure, preserves function, and increases survival.' Patients on home mechanical ventilation use their respirator intermittently (at least three hours per day) or continuously, with either a tracheostomy, a mouthpiece, or a face or nasal mask, or an external device such as a cuirass or a poncho suit. Consequently, home mechanical ventilation is the longer term application of ventilatory support to patients who are no longer in acute respiratory failure and do not need the sophistication of an intensive care unit.' According to the guidelines for long term mechanical ventilation published by a task force of the American College of Chest Physicians,2 the goals of home mechanical ventilation must include the following: (1) extend life; (2) enhance the quality of life; (3) provide an environment which will enhance individual potential; (4) reduce morbidity; (5) improve physical and physiological function; and (6) be cost beneficial. Several meetings and consensus conferences"3have emphasised the importance of identifying the problems relative to equipment, the assessment of individual needs, appropriate levels of care, and adequate long term reimbursement which have been treated differently in most countries.