Home Mechanical Ventilation in Central Taiwan: Experiences at China Medical College Hospital

Abstract

Objective. To ascertain the outcome, benefits, and complications of patients using home care ventilation. Methods. We reviewed the hospital charts and clinical records of all patients who had been admitted to our hospital and used a mechanical ventilator at home from 1991 through 1998. The starting point for data collection on survival was the date of discharge from the hospital. The end point was either the patient's death or the time when support using a mechanical ventilator was discontinued. The mortality rate was calculated. The cost data for the different types of ventilators were obtained from two local vendors. The cost of disposable respiratory care items (suction catheters; sterile water) was obtained by averaging the expenses from five patients. Nursing charges were surveyed for our community. Medications varied widely among patients and were not included in the estimated costs of care using a ventilator at home. Results. Twenty-six adult and five children with chronic respiratory failure are enrolled; 18 (58%) of them had neuromuscular diseases (including central nervous system disorders), and four had injuries to the spinal cord. Three of the patients used non-invasive bi-level positive pressure ventilators and two used negative pressure ventilators. Among the 31 patients, four were eventually weaned from the ventilator, and 11 (36%) died at home or in the hospital due to disconnection from the ventilator other complications. The mortality rate was greater for adults than for children. For the majority of the patients, the cost of management at home was significantly less than the cost of management in the hospital, depending largely on the level of nursing care required. Conclusions. We suggest that mechanical ventilation at home is a reasonable alternative to prolonged hospitalization on for medically stable ventilator-dependent patients, and non-invasivemechanical ventilation may be useful for some patients. ”