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Mechanical Ventilation in Nontraditional Settings 587

ventilator care requires a total commitment from family members. They must also
be able and willing to assume this unfamiliar task of home ventilator care for the
duration of time that the patient remains on the ventilator. In one study, the most
important factor associated with adaptation of home ventilator care was the level
of communication within the family and the degree of commitment between all
family members (Glass, 1993).
Cost. The cost of home ventilator care varies greatly and depends primarily on the
type of equipment and the extent of professional care required. A ventilator, a
backup ventilator, and oxygen supplies are some major equipment expenditures,
obtained either by purchase or through a rental agreement. Having medical profes-
sionals at home on a regular daily schedule may sometimes be necessary. Depend-
ing on the patient’s needs, receiving home care provided by nurses and respiratory
therapists can be a costly expenditure (Murray, 1989; O’Donohue et al., 1986).
The complexity and available features of a ventilator can affect the equipment
cost. As a rule, more complex equipment and supplies cost more. For patients who
cannot breathe spontaneously and require continuous ventilatory support, a backup
ventilator may also be necessary. Those patients who require around-the-clock care
may also need medical professionals to make frequent home visits. Family members
may also need to hire a home care aide to provide periodic relief for leisure time and
other family or work obligations.
A study on the financial aspects of pediatric home ventilator care shows a signifi-
cant reduction in the total cost (Hazlett, 1989). Of course, home ventilator care
cannot be justified from a financial standpoint if its total cost is higher than the cost
of comparable hospital care. Careful cost analysis should be done based on the pa-
tient’s requirements. The resultant cost for the entire home ventilator care program
may be part of the patient selection process.

Available Resources. The primary resources that are vital to the success of home ven-
The primary resources tilator care include physical resources, technical support, and emotional support.
that are vital to the success of
home ventilator care include The physical resources for home ventilator care must provide adequate space for
physical environment, techni- the ventilator, a special bed, a wheelchair, oxygen units, and supplies. Suitable and
cal support, and emotional
support. sufficient electrical outlets are also needed for the ventilator, alarms, and other
related equipment. Technical support should include one or more home health
agencies that have ample equipment and supplies, qualified medical professionals,
and around-the-clock coverage. Emotional support may include psychosocial assis-
tance provided to the patient and family members by community agencies, support
groups, and friends.

Equipment Selection

Although positive pressure ventilation with an artificial airway is the most common
modality in home ventilator care, there are several factors to consider before prescrib-
ing the equipment for the patient. The primary factor of equipment selection should
result in a ventilator or device that suits the patient’s immediate and long-term needs.
The secondary factor should deal with the use and maintenance of the equipment.

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