chapter  18
20 Pages

Discharging the ventilator-dependent patient and the home ventilatory care network A K Simonds

Goals of home ventilation 229

Evolution of non-invasive ventilation demographics 230

Decision-making 231

Non-invasive or tracheostomy ventilation? 232

Home care network 235

Funding and organizational aspects 244

Discharge of the ventilator-dependent child: a model of care 246

Alternatives to home care 247

References 247

GOALS OF HOME VENTILATION

Discharging a ventilator-dependent patient home is a challenging process that needs to be achieved as seamlessly as possible. The complexity of arrangements will clearly differ in a patient receiving 24-hour tracheostomy ventilation for a progressive neuromuscular disease, compared with those for a stable scoliotic patient using nocturnal nasal ventilation. For the purposes of this chapter ventilator dependency is defined as the requirement for ventilatory support at least 6 hours a day for more than 30 days. The goals of long-term home ventilation are listed in Box 18.1.