Page 616 - Clinical Application of Mechanical Ventilation

582 Chapter 18

MECHANICAL VENTILATION AT HOME

Home mechanical ventilation (HMV) made its first appearance in the United
States during the poliomyelitis epidemics of the mid-twentieth century. At that
time, negative pressure ventilators (iron lungs) were used to sustain the lives of
those who lost the ability to breathe. Today, health care reform and cost contain-
ment strategies are limiting the resources available for acute care in the hospitals.
Since there are few nursing homes or extended care facilities that will accept the
increasing number of ventilator patients, home care becomes an important and vi-
able option for ventilator-dependent patients.

Goals of Home Mechanical Ventilation (HMV)

Mechanical ventilation provided in the home is drastically different from that de-
livered in an acute care setting. In an acute care setting such as the hospital, the
patient is surrounded by an array of medical equipment and supplies. Specialized
health care providers are available at all times to provide diagnostic and therapeutic
procedures. In addition, the patient in an acute care setting gets little rest because
of frequent vital sign assessments and routine laboratory tests. For patients who re-
quire long-term mechanical ventilation, it may not be logical or financially feasible
to provide mechanical ventilation in an acute care setting.
An alternative to the acute care setting is to provide mechanical ventilation in a
nonacute environment such as the patient’s home. Three unique and beneficial goals
of home ventilator care have been identified as follows (O’Donohue et al., 1986):
1. Extension of the patient’s life and enhancement of the quality of life

2. Creation of an environment that will develop and strengthen the patient’s
physical and physiological functions

3. Reduction of the cost for HMV
Extension of the patient’s life is a primary goal of medical and health care procedures.
Quality of life is an important issue since a life that has poor quality or little meaning
may cause the patient a great deal of anxiety and unnecessary suffering. For this reason,
the patient must be involved and be part of the decision-making process before chang-
For patients receiving ing the ventilator care plan from an acute care setting to the patient’s home.
mechanical ventilation at
home, to be able to spend To be able to spend much of the day in a familiar home environment is one
much of the day in a familiar benefit that cannot be provided by the hospital. At home, the patient is likely to
home environment is one
benefit that cannot be pro- become more active in the rehabilitation process. There is an incentive for the pa-
vided by the hospital.
tient to try to get well and be weaned off the ventilator. Furthermore, interactions
with family members and friends will enhance the patient’s psychologic well-being
and quality of life.
Reduction of the cost for patient care is another goal of HMV. The cost savings
Reduction of the cost for of providing mechanical ventilation at home can be drastic but should not be the
patient care is another goal of
home mechanical ventilation. primary consideration. It is vital to ensure that quality care is provided to the patient
at or below the cost of patient care in an acute care setting.

Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.