Vol. 16 •Issue 8 • Page 15
Patient Primer
The Next Step: Home Ventilation
Living independently at home offers ventilator-dependent patients an attractive option. It costs substantially less than hospital care, can improve quality of life, and gives more opportunity for social relationships. But home ventilation isn’t ideal for every patient.
Hospital staff will need to assess your health and home to make sure both are safe and stable enough to allow this transition. Home care also requires physical, emotional, and financial support, so you should discuss these considerations with the hospital staff when deciding if it’s the right choice for you and your family.
If you’re a good candidate for home care, the hospital discharge process takes about two weeks to complete. You will meet to discuss your care plan with a team of health professionals, which may include the physician, respiratory therapist, nurse, speech therapist, insurance provider and case manager, and home medical equipment (HME) provider.
Your family members or friends must be willing and able to act as caregivers and cooperate with the care plan. The doctor will write orders for the required home care equipment and settings. In some cases, with a doctor’s permission and training, patients can modify their therapy within a window of values the doctor has set.
Equipment and training
A physician and respiratory therapist will work with you to determine if noninvasive or invasive ventilation will be most beneficial. Noninvasive methods use masks, nasal tubes, and other techniques whereas invasive ventilation uses a tracheostomy, a surgical hole in the windpipe that uses a tube to assist breathing.
With either method, patients and caregivers must learn to operate and troubleshoot the ventilator, to perform maintenance, and to use infection control techniques. The hospital staff or home ventilator company should offer this training at the hospital and at home prior to your discharge.
Preparing your home
As the new care setting, your home environment also plays an integral role in this process. Have your electric service examined to ensure it can support the additional electrical requirements of the ventilator and other necessary medical equipment. Also notify your telephone and electric companies to place you on their priority reconnect list, and have a list of important phone numbers near your home phone in case of emergency. Keep a battery or generator handy in case of a short-term power outage, and check it weekly to make sure it’s fully charged.
Making this transition can be both exciting and challenging, so be sure to discuss special considerations and concerns with your health care professionals and HME provider.
Information adapted from the International Ventilator Users Network, www.chestnet.org, and “Transitioning the Ventilator-dependent Patient From the Hospital” by Joan Kohorst, MA, RRT.
Colleen Mullarkey is editorial assistant of ADVANCE. She can be contacted at [email protected].
Common ventilator modes
Control: delivers controlled breaths triggered by a pre-set machine rate and doesn’t allow the individual to take any spontaneous breaths.
Assist/Control: allows the individual to trigger a machine-assisted breath and to take additional breaths at prescribed tidal volume.
SIMV (synchronized intermittent mandatory ventilation): operates with prescribed tidal volume and respiratory rate, but the individual can breathe spontaneously in between delivered breaths.
PEEP (positive end-expiratory pressure): maintains airway pressure at the end of the ventilator breaths to increase the volume of air when the lungs empty.
