Long-term ventilation

Stymme, H., Emenius, G. and Boman, C. (2005) Long term ventilation variation in two naturally ventilated Stockholm dwellings. Proceedings of Indoor Air 2005, September, 4—9, Beijing, China, pp. 3239-43. 

The most complete European data on the use of HMV has been reported recently as the Eurovent study, a survey of long-term ventilator use conducted in 16 countries (15). In this survey, home ventilation was defined as ventilatory assistance for three months or more. Those receiving other forms of ventilation, such as rocking beds, negative-pressure ventilation, and phrenic nerve stimulation, were included. A total of 483 surveys were sent to the centers prescribing HMV in the 16 countries, with 329 centers (68%) responding. The numbers of patients and prevalence rates were estimated for each country. As noted in Table 3, there was a wide variation in the prevalence of HMV in Europe, ranging from 0.1/ 100,000 population in Poland to 17/100,000 in France. The survey identified a total of 21,526 VAIs and estimated the prevalence of HMV to be 6.6/100,000 population in Europe. 

In a retrospective study of 319 patients, multivariate analysis identified shock on ICU admission day as the only independent predictor for PMV (>21 days) (47). In a prehminaty study of 111 patients, increased duration of MV and need for transfer to a long-term ventilator care facility was associated with a creatinine elevation of 1.3 mg/dL anytime during the ICU stay (48). In another study, none of the 52 patients with PMV and renal failure were successfully weaned (49). Chao and colleagues reviewed >1000 patients transferred to their regional weaning center and identified 63 with renal dysfunction, with creatinine >2.5 mg/dL (40 on renal replacement therapy) (50). When compared to those with creatinine <2.5 mg/dL, patients with renal dysfunction were less likely to wean from MV (13% vs. 58%). 

Cordasco EM, Jr., Sivak ED, Percz-Trepichio A. Demographics of long-term ventilator-dependent patients outside the intensive care unit. Cleve Clin J Med 1991 58(6) 505-509. 

Dasgupta A, Rice R, Mascha E, et al. Four-year experience with a unit for long-term ventilation (respiratory special care unit) at the Cleveland Clinic Foundation. Chest 1999 116(2) 447 55. 

Causes of Difficult Weaning Which Mechanisms Are Associated with Long-Term Ventilator Dependence ... 

Figure 1 Conceptual framework linking acute or acute-on-chronic lespiratray failure to jaolonged mechanical ventilation and long-term ventilator dependence. Differences in patient population, imprecise nosology, and paucity of research make it difficult to provide solid indications for when patients may transition from one condition to the next.

Specific conditions such as idiopathic central alveolar hypoventilation syndrome (Ondine s curse) or central alveolar hypoventilation syndrome secondary to neurological lesions (trauma, infections, infarction. Shy Drager syndrome) can cause or contrihute to long-term ventilator dependence (40). In most ventilator-dependent patients, however, estimations of respiratory drive indicate that drive is increased and not decreased (18,41-43). 

Figure 8 Continuous recordings of airflow (Flow) and esophageal pressure (Pes) in a long-term ventilator-dependent patient with COPD during a brief period of unassisted breathing. Arrows indicate ineffective inspiratory efforts—inspiratory efforts not associated with inspiratory flow. In one study (41), ineffective inspiratory efforts were recorded in 40% of long-term ventilator-dependent patients with COPD but not in patients with COPD who were successfully weaned after a period of prolonged ventilatory support. Abbreviations Pes, esophageal pressure COPD, chronic obstructive pulmonary disease. Source From Ref. 41.

Douglas SL, Daly BJ, Gordon N, et al. Survival and quality of life short-term versus long-term ventilator patients. Crit Care Med 2002 30(12) 2655-2662. 

Douglas, SL. Caregivers of long-term ventilator patients physical and psychological outcomes. Chest 2003 123(4) 1073-1081. 

Hewitt-Taylor J. Children who require long-term ventilation staff education and training. Intensive Crit Care Nurs 2004 20 93-102. 

In this chapter, we describe possible alternate settings for a VAI unsuitable for the ICU or the home environment. We discuss outcomes of care and provide indications for making decisions regarding the most appropriate site for long-term ventilation. 

Prentice WS. Placement alternatives for long-term ventilator care. Respir Cate 1986 31 (4) 199-204. 

Ambrosino N, Vianello A. Where to perform long-term ventilation. Respir Care Clin N Am 2002 8(3) 463-478. 

Criner GJ. Long-term ventilation introduction and perspectives. Respir Care din N / 2002 ... 

Patients with thoracic restriction or advanced parench)mial diseases, who develop respiratory failure, represent a heterogeneous group. For such patients, nocturnal noninvasive ventilation is the preferred alternative. The results are very encouraging among those with stable thoracic restriction and less clear among those with advanced parenchymal diseases. The development of specialized facilities for long-term ventilation is described elsewhere in this book. 

NIV is often an effective treatment for patients with acute respiratory failure, especially when secondary to exacerbation of chronic obstructive pulmonary disease (COPD) (24). NIV is also utilized for long-term ventilation (LTV) of patients with chronic respiratory failure due to thoracic restriction or NMD. It is used less frequently for COPD as there is only limited evidence of its long-term effectiveness in this condition (25). In stable patients, NIV is affected by the type of interface used (26). 

Jardine E, O Toole M, Paton JY, et al. Current status of long term ventilation of children in the United Kingdom questionnaire survey. Br Med J 1999 318 295-299. 

In this case, the patient and his family had initially chosen a very active level of eare, including transplantation. When his respiratory condition worsened and they had to make another decision regarding the intensity of therapy in the face of apparently irreversihle disease, they chose a time-limited trial of intuhation. Patients often tell us they do not want to be on a long-term ventilator, but they would like a trial to see if some part of the ehnie picture is reversible. Chronie rejeetion meant this patient s survival off the ventilator was not possible, and the patient and his family elected to prioritize comfort care. The morphine drip was begun as part of the patient s end-of-life care, and to the surprise of his family and... 

Gibson BE. Long term ventilation for patients with Duchenne muscular dystrophy an ethical analysis of physicians beliefs and practices. Chest 2001 119(3) 940-946. 

Long-Term Ventilation The North American Perspective... 

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