Long-term ventilation introduction

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

In contrast to some countries, the polio epidemics of the 1950s did not trigger the initiation of long-term ventilation (LTV) in Japan (1). The first patient to receive LTV at home was in Tokyo in 1975, when an adult with neuromuscular disease (NMD) received tracheal invasive positive pressure ventilation (TIPPV) (2). Despite the introduction of public assistance for costs associated with home mechanical ventilation (HMV), fewer than 200 patients were receiving HMV between 1990 and 1993 (Fig. 1) (2). 

Exposure to VCM has been shown to lead to two distinct problems. In the mid-1960s it became clear that a number of workers involved in reactor cleaning suffered from a bone condition called acroosteolysis (AOL), which affects mainly the hands and feet. Removal of the worker from exposure to VCM leads to an almost complete recovery. Since improvements to ventilating reactors and the introduction of high pressure water cleaning the incidence of AOL has ceased (65). A study of long-term exposure of rats to 30,000 ppm VCM did not reproduce any sign of AOL but they did develop cancers in various sites (66). 

The 1960s witnessed the continued support of some polio patients at home, as well as the introduction of mouthpiece ventilation for long term, even continuous, support at some specialized rehabilitation hospitals (4). The 1960s also ushered in intensive care units (ICUs) that served as specialized centers to treat patients with acute respiratory failure. Sophisticated mechanical ventilators were developed to treat these patients. Some of whom failed to wean and often spent weeks or months in these units because no other facilities were available to adequately care for them. 

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