ABSTRACT
The assessment of home discharge and follow-up of the patient with chronic respiratory failure who is medically stable, but requires homemechanical ventilation (HMV), can be complex (1). In the United Kingdom, guidelines are available for pediatric patients (2), but not for adults. Patients considered for HMV vary from the failed-to-wean critical care patients to those with chronic respiratory failure, associated with thoracic restriction disease (TRD), neuromuscular disease (NMD), spinal cord injury (SCI), or chronic obstructive pulmonary disease (COPD). Some commence noninvasive ventilation (NIV) electively after referral to a respiratory specialist. Adequate planning will increase the chances of a successful outcome for the patient, family, and caregivers as well as improve the quality of life of the patient (3). In this chapter, we will discuss the predischarge planning, discharge home, and the follow-up required to achieve successful discharge of the adult ventilated patient (4). There are several barriers to the discharge of children and young people, including the attitude of professionals, the lack of joint commissioning, the lack of ongoing accountability, as well as poor management within health care systems and other partner agencies. These issues are also reflected in the adult population, especially among those ventilated with a tracheostomy. Domiciliary ventilation may be noninvasive or invasive, and ventilation times vary from a few hours at night to total 24-hour ventilation.
