1996 OPEN FORUM Abstracts
Home Care Ventilators: A Critical Review of Current Models and Options
Ray Ritz, RRT Monday, November 4, 1996
Long term mechanical ventilation has been utilized for over 50 years and has consistently evolved to a more sophisticated level each year. Current ICU ventilators offer an impressive array of modes and options all designed to support ventilation over a wide range of disease states. Home ventilators have also seen noticeable improvement but are designed specifically to be less sophisticated. AARC Clinical Practice Guidelines state that ventilators for home use be dependable and easy for a variety of care givers to operate. These ventilators should be sufficiently portable, offer an adequate power source, and alarms which are adequate to alert the care giver to a patient disconnect. Excessive complexity in a home care ventilator is clearly a detriment.
Currently four US and four European manufactures offer home care ventilators. Of these eight manufactures, 14 currently or recently offered ventilators will be reviewed. These include the Puritan-Bennett Companion 2800, 2801, and 2500; the Aequitron Medical Inc. LP-6, LP-10, and LP-6+; the Lifecare PLV-100,and PLV-102; the Intermed Bear 33; the Breas 501; the Bio MS Airox Home 1; the SAIME Eole 2: and the L'Air Liquide Monnal D and Monnal D-CC.
Each unit will be evaluated for its design, alarms, modes, data display, and power source. The use of a rotary piston is the common flow delivery mechanism in most (but not all) home ventilators. Microprocessors are commonly use to control the systems functions. The ability to deliver supplemental oxygen with each device will be assessed. Each device will be evaluated for the available ranges in tidal volumes, rates, inspiratory times, flow rates, trigger sensitivity, sigh volumes and rates, I:E ratios, and the availability of PEEP.
Current literature indicates that spontaneously breathing patients can encounter significant work in the IMV mode with these devices. Suggestions for reducing this work will be offered.
For those patients who do not require invasive mechanical ventilation, a brief review of negative pressure systems, pneumobelts, and rocking beds will be covered. Special attention to patient selection and possible complications with these devices will be addressed.