A patient who is in immediate need of an acute care setting is not a candidate for in-home ventilatory support. Other contraindications include unstable cardiac and respiratory status or an unstable or inadequate home setting without competent family members who are always available.
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 support 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 of the patient’s ventilatory effort. Most patients receiving long-term invasive ventilatory support have a tracheostomy tube in place to enable ventilator support, but they no longer require intensive monitoring.1
Long-term invasive mechanical ventilation provides mechanical ventilator assistance to patients who have been diagnosed with chronic respiratory illnesses or respiratory insufficiency. 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 increasing ventilator support.
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
Home mechanical ventilation for children with chronic respiratory insufficiency is a well-established treatment.
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.
Rationale: The use of SIMV for portable volume control ventilators increases the work of breathing.
Heuer, A.J. (2021). Chapter 57: Respiratory care in alternative settings. In R.M. Kacmarek, J.K. Stoller, A.J. Heuer (Eds.), Egan’s fundamentals of respiratory care (12th ed., pp. 1279-1298). St. Louis: Elsevier.
*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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