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Mechanical Ventilation in Nontraditional Settings 583

As we shall discuss later in this chapter, the success of an HMV program requires
No matter what their a team that consists of medical professionals (e.g., physicians, nurses, respiratory
background or training, a
team approach dedicated and therapists, durable medical equipment specialists, dietitians, social workers, and so
committed to quality care is on) and nonmedical laypersons (e.g., relatives, friends, and support group mem-
vital to any successful home
ventilator care program. bers). No matter what their background or training, a team approach dedicated and
committed to quality care is vital to any successful home ventilator care program
(Gower et al., 1985).

Indications and Contraindications

HMV requires a detailed discharge plan because it involves many different agen-
Caretakers involved with cies, departments, and caretakers. Caretakers involved with HMV must be willing
HMV must be willing and able
to perform the task of taking and able to perform the task of taking care of the patient, ventilator, airway, and
care of the patient, ventilator, related medical devices and supplies. For these reasons, the indications for HMV
airway, and related medical
devices and supplies. must be clearly defined and they should be based on individual needs.
Indications. Before a decision is made to provide HMV for a patient, four needs-
assessment questions should be thoroughly evaluated. The final decision must be
based on the answers and solutions to these questions and on the available resources
to rectify any remaining patient care issues. The four needs-assessment questions are:
1. Does the patient have a disease state (e.g., high cervical spine injury, severe respi-
ratory muscle paralysis) which may result in persistent ventilatory failure and an
inability to be completely weaned from invasive ventilatory support?
2. Does the patient exhibit clinical characteristics (e.g., impending ventilatory
failure, cerebral hypoxia) that require mechanical ventilation?
3. Is the patient clinically stable enough to be managed outside an acute care
setting?
4. Are there other noninvasive alternatives besides artificial airway and mechani-
cal ventilation (e.g., diaphragm pacing, pneumobelt) suitable for the patient?
(AARC CPG, 2007; O’Donohue et al., 1986.)

Diseases That May Benefit from HMV. Lung diseases that may justify HMV outside
an acute care setting may be grouped into four categories (Table 18-1). They are:
1. chronic obstructive lung diseases (COPD);
2. restrictive lung diseases;

3. ventilatory muscle dysfunction; and
4. central hypoventilation syndromes (Ferns, 1994; Goldstein et al., 1995;
O’Donohue et al., 1986).
HMV should not be Since the severity and coexisting conditions of a disease vary greatly among patients
initiated if the patient has any with the same diagnosis, a thorough patient evaluation is a prerequisite for HMV.
unstable medical condition
that requires complicated pro- Contraindications. HMV should not be initiated if the patient has any unstable medical
cedures or involves specialized
health care personnel. condition that requires complicated procedures or involves specialized health care
personnel. Examples may include patients with frequent and progressive arrhythmias,

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