A patient who requires a positive end-expiratory pressure (PEEP) setting above 10 cm H2O or who has a fraction of inspired oxygen (FIO2) requirement of more than 0.4 (40%) is not a candidate for long-term invasive mechanical ventilation in the home.undefined#ref1">1
Every respiratory therapist (RT) and home health practitioner must be familiar with state, Medicare, and Medicaid guidelines for providing care to a patient receiving home mechanical ventilation because guidelines may vary among states.
Mechanical ventilation is a life-support system used to assist or control ventilatory lung function. Patients who become ventilator dependent exhibit an imbalance of ventilatory capacity and demand. Levels of ventilator support range from assisting the patient’s work of breathing to controlling all the patient’s ventilatory effort. Patients receiving long-term invasive ventilatory support should have a tracheostomy tube in place to enable ventilator support, but they no longer require intensive monitoring.1
Long-term invasive mechanical ventilation in the home provides a more comfortable and cost effective option for patients with chronic respiratory failure who have recovered from an acute event in an acute care facility.2,3 Patients who may benefit from a long-term home ventilator are limited to those who cannot be completely weaned from invasive ventilator support and those who have a disease progression that requires ongoing assistance with breathing or gas exchange.
The number of patients requiring long-term invasive mechanical ventilation has increased in recent years because of improved care provided in the critical care setting. This improved care has allowed patients to survive acute respiratory failure, some of whom require long-term invasive mechanical ventilation during recovery.2
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Rationale: Mode selection varies depending on the clinical goal and the practitioner’s preference. Ventilators chosen for use at home must be dependable and easy for family members to operate and must allow mobility.1
Rationale: The use of SIMV for portable volume control ventilators may increase the work of breathing.1
Janssens, J-P. and others. (2020). Long-term mechanical ventilation: Recommendations of Swiss Society of Pulmonology. Respiration, 99, 867-902. doi:10.1159/000510086
Park, S., Suh, E-S. (2020). Home mechanical ventilation: Back to basics. Acute and Critical Care, 35(3), 131-141. doi:10.4266/acc.2020.00514
*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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