The Chronic Assisted Ventilatory Care Unit

Unfortunately, it is not always possible—often because of the lack of family support and the unavailability of home care. One of the most viable alternatives is the chronic assisted ventilatory care unit (CAVC). In this chapter, we will discuss CAVC, based on our experience in such a unit, located in a center that specializes in rehabilitation and complex continuing care center. 

Long-term care has evolved from being essentially custodial to offering more comprehensive management for complex patients with multiple comorbidities. The CAVC unit is an example of this direction. 

The unit has demonstrated that ongoing ventilatory support can be safely provided outside of the acute care setting. Its main achievements include providing a safe environment with a rehabilitative focus that will promote functional ability and autonomy among ventilator-assisted individuals (VAI). 

Since its inception in 1986 in response to the growing need for a more appropriate environment for LTMV patients, our unit has expanded from 5 to 22 beds. For the CAVC unit to be successful, it is important to carefully select patients who meet written admission criteria, to have an interdisciplinary clinical team with technical knowledge and experience, and to have the capability for the ongoing monitoring of ventilation and gas exchange. 

An example of admission criteria is found in Table 1. All patients have a preadmission assessment by the multidisciplinary team to ensure that they are appropriate to the CAVC environment and can safely be cared for outside of the acute care environment. A smooth transition from acute care is very important, especially for individuals who have been in such a sheltered ICU environment for a long time. Patients and families are usually apprehensive about leaving the intensive nursing and monitoring environment of the ICU. Therefore, patients able to be transported to the CAVC unit are assessed there to provide them and their families the opportunity to visit the unit, thus making the subsequent transfer a little less stressfiil. 

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