Page 620 - Clinical Application of Mechanical Ventilation

586 Chapter 18

often recover and do not require prolonged mechanical ventilation except in cases
of high spinal injuries (e.g., cervical 1 and 2). Aggressive airway care and broncho-
pulmonary hygiene should be done to avoid complications resulting from the use of
mechanical ventilation and artificial airway.

Central Hypoventilation Syndrome. Patients with central hypoventilation syndrome
often exhibit apnea or variable periods of hypoventilation due to failure or dys-
function of the autonomic control of breathing. Because of the range of severity
and complications in central hypoventilation syndrome, some patients may require
mechanical ventilation only during sleep while others may need it continuously. In
patients who have persistent hypoventilation, poor lung expansion may lead to lung
infection, atelectasis, and pneumonia. Careful evaluation of these patients in the
hospital can help to formulate a care plan for mechanical ventilation in the home.

Patient Selection

Not all patients receiving mechanical ventilation in an acute care setting are suit-
able candidates for home ventilator care. Typically, a patient who requires a good
deal of monitoring and laboratory tests or one who is clinically unstable is ruled out
for home ventilator care. Aside from the evaluations based on the medical perspec-
tive, four nonmedical factors are crucial in the patient selection process. They are:
1. desires of the patient;

2. desires of the family;
3. cost; and
4. available resources (Eigen et al., 1990; O’Donohue et al., 1986; Smith, 1994).

Desires of the Patient. Likely candidates for home ventilator care should be informed
One disadvantage of about the potential advantages and disadvantages of leaving the hospital. The ad-
leaving the hospital is the
feeling of isolation from vantage of being at home is the opportunity for the patient to stay closer to family
professional care and the members and to live in a familiar environment. One disadvantage of leaving the
assumption of medical care
mainly by family members. hospital is the feeling of isolation from professional care and the assumption of
medical care mainly by family members. The topic of home ventilator care should
be discussed when the patient can comprehend the meaning and implications of
leaving the acute care setting. It should not take place when the patient is hypoxic,
confused, or under emotional distress.
Finally, the decision to implement home ventilator care should not be rushed.
Ample time should be provided to the patient so that the decision may reflect the
patient’s true desire. Hasty discussions and decisions often lead to inaccurate per-
ceptions and poor transition from the hospital to the home care setting.

Successful home Desires of the Family. The desires of family members must be considered because
ventilator care requires a total
commitment from family they will be the key persons taking care of the patient and ventilator at home.
members and a high level of Depending on the level of ventilator care required by the patient, personal sacri-
communication within the
family. fices must be made. These sacrifices may range from giving up some free time and
leisure activities to terminating one’s job or career (Smith, 1994). Successful home

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