Respiratory Equipment in Alternative Sites

List and describe the differences between mechanical ventilation in the home and mechanical ventilation in an acute care setting
Background

Mechanical ventilation provided in the home is drastically different from that delivered in an acute care setting. In an acute care setting such as the hospital, the patient is surrounded by an array of medical equipment and supplies. Specialized health care providers are available at all times to provide diagnostic and therapeutic procedures. In addition, the patient in an acute care setting gets little rest because of frequent vital sign assessments and routine lab tests. An alternative to the acute care setting is to provide mechanical ventilation in a non-acute environment such as the patient’s home. Extension of life is the primary goal of medical and health care procedures. Quality of life is an important issue, for this reason, the patient must be involved in the decision-making process before changing the ventilator care plan from an acute care setting to the patient’s home. When patients require long-term mechanical ventilation beyond the acute care setting, there are many factors that must be considered such as:

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Indications of need
Patient unable to be weaned for invasive support
Progression of the disease
Contraindications
Unstable condition without resources in the home setting
Unsafe physical environment
Patient non-compliant
Non-financial resources
Precautions and possible complications
Medical problems that return the patient to acute status
Equipment malfunctions or failure of the ventilator operation
Assessment of outcome
Determine is indications are present and contraindications are absent
Determine if therapy will sustain the patient’s life and reduce mortality
Monitoring
Patient’s physical condition
Ventilator settings
Equipment function
The plan of care

Most patients who require ventilator support outside the acute care hospital fall into one of the three broad categories.

The patient is unable to maintain adequate ventilation (elevated PaCo2)
The patient requires ventilation for survival
The patient is terminally ill with a short life expectancy

Home Mechanical Ventilation (HMV)

HMV requires a detailed discharge plan because it involves many different agencies, departments and caretakers. Before a decision is made to provide HMV for a patient, four needs-assessment questions should be evaluated. The four questions are:

Does the patient have a disease state, high cervical spine injury, severe respiratory muscle paralysis, which may result in persistent respiratory failure and an inability to be completely weaned from invasive ventilator support?
Does the patient exhibit clinical characteristics (impending respiratory failure, cerebral hypoxia) that require mechanical ventilation?
Is the patient clinically stable enough to be managed outside an acute care setting?
Are there other noninvasive alternatives besides artificial airway and mechanical ventilation for the patient?

Diseases That May Benefit from HMV

Chronic obstructive pulmonary disease (COPD)
Restrictive lung disease
Respiratory muscle dysfunction
Central hypoventilation syndromes

Invasive versus Noninvasive Ventilation Support

Noninvasive ventilation (NIV) is the first choice if the following conditions are met:

The patient must be mentally competent, cooperative, and are using limited sedation or narcotics
The patient needs a minimal amount of oxygen (less than 40%)
The patient is able to maintain oxygen saturation greater than 90%
The patient has normal swallowing and airway protection
The patient does not have a history of seizures or substance abuse
The patient does not have facial trauma

Patients who benefit from usually fall into two categories:

Conditions that could lead to imminent death
Patients with asthma
Acute exacerbation of COPD or pulmonary edema
Quadriplegia or patients with certain neuromuscular disorders
Conditions that do not lead to imminent death
Chronic Neuromuscular and chest wall diseases

Invasive ventilation is especially used for patients who require long-term pressure ventilation by tracheostomy. This method is associated with potential problems including secretion retention, infection, aspiration, and ventilator-associated pneumonia.

The preferred location for long-term mechanical ventilation is in the home because costs are reduced, quality of life is enhanced, and integration into the community is maximized. The indications for both invasive and noninvasive mechanical ventilation support in the home are increasing as technology and infrastructure support improves; however, reimbursement constraints make it challenging to provide home ventilator patients with the optimal equipment and services required. A central registry would allow for the development and monitoring of national home mechanical ventilator patient outcomes.

Equipment

The choice of a ventilator is determined by the patient’s clinical need and available support resources.

Watch this video on ventilator management. You will gain a better understanding of how patients live daily by means of home mechanical ventilation.

Adult home ventilation (total time 5:43 minutes)

Home Mechanical Ventilation CH 07-Ashley's Story
(Links to an external site.)

Child Home Ventilation (total time 5:21 minutes)

Watch this video on home continuous positive airway pressure (CPAP). You will gain a better understanding of the pros and cons of its use in the home care setting.

Home Mechanical Ventilation CH 02-HMV Considerations
(Links to an external site.)

CPAP Therapy (pros and cons of CPAP; total time 5:04 minutes)

The Pros and Cons of Using CPAP
(Links to an external site.)

Negative Pressure Ventilation Iron Lung (total time 3:13 minutes)

Watch this video on the Iron lung and its function. You will gain a better understanding of how mechanical ventilation was performed in the 1950s.

The Iron Lung
(Links to an external site.)

Prompt

In your assignment this week, you will describe types of respiratory care delivered in alternative sites. Your responsibility as a home RT is to educate the patient and family about the care they will receive. For each of the therapies provide the following information.

Fully define the therapy and include the a. Indication for use b. Hazards and c. procedure for set-up.

1. Bland Aerosol Therapy

2. Aerosol Drug Therapy

3. Continuous Positive Airway Pressure Therapy (CPAP)

4. Apnea Monitoring

Submit your answers in at least 500 words on a Word document. You must cite at least three references in IWG format to defend and support your position.

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