1997 OPEN FORUM Abstracts
Use of Ventilators in the Home
Robert M Kacmarek, PhD, RRT, Tuesday, December 9, 1997.
Today there are numerous mechanical ventilators available for use in the home. They range from volume cycled positive pressure ventilators to rocking beds. Each of these categories of ventilators has been used extensively. However, the volume ventilators are the most commonly used ventilators of the group. Volume ventilators designed for home use ventilate in the same manner as volume ventilators designed for use in the ICU. However, WOB is markedly increased in the SIMV mode and none of the volume ventilators currently available have PEEP integrated into the basic operation of the ventilator. Although these ventilators can be used noninvasively they have been primarily used invasively in patients tracheostomized. Bilevel pressure ventilators are being used increasingly to provide noninvasive ventilatory support via nasal mask in the home. These units are not, however, appropriate for use in patients tracheostomized who require ventilatory support. None of the pressure ventilators include an internal battery and few are appropriately monitored or alarmed. As a result, in spite of an optimal gas delivery system they can not be considered safe for use in the home setting for patients requiring invasive ventilatory support. The group of ventilators available for home use that are frequently forgotten include negative pressure ventilators, rocking beds and pneumobelts. These devices are for primary use in patients whose ventilatory problems are not of primary pulmonary origin (i.e. neuromuscular/neurologic in origin). All of these devices can be used (during the day) in association with noninvasive positive pressure ventilation (during the night) as a means of supporting patients during the day in an effort to increase ventilator (positive pressure) free time. Negative pressure ventilators are the most efficient of the group and a customized chest cuirass is the most successful method of application. They are however large and cumbersome and require care giver assistance for application. The pneumobelt is very useful for the neurologic/neuromuscularly diseased patient who can sit at a 45º angle. Tidal volumes in the none obese patient can approach 400-500 mL with this device. Rocking beds are the least efficient and most cumbersome of all home care ventilators and only result in acceptable gas exchange in patients with moderate abdominal size and no pulmonary disease. The rocking movement of the bed shifts the abdomen assisting spontaneous ventilation. Before committing a home care patient who requires ventilatory support to a trachesotomy and invasive volume ventilation, all of these potential options should be considered especially if the patient has neurologic/neuromuscular disease without primary pulmonary disease.
AARC 50th Anniversary, December 6 - 9, 1997, New Orleans, Louisiana.