ABSTRACT
Long-term mechanical ventilation (LTMV) refers to a variety of techniques available to treat chronic respiratory failure. The definition is predicated on prolonged mechanical ventilation (PMV), but the requisite length of time varies. For practical purposes, this discussion considers LTMV as ventilation taking place for >21 days, for at least 6 hr/24 hr. The techniques to provide LTMV have evolved over the past century, in parallel with advancing understanding of the pathophysiology of chronic respiratory failure. The ultimate goals of LTMV are similar worldwide-to maintain adequate gas exchange and return the patient to the highest level of function, ideally at home. However, depending on the patient’s care needs, the attainment of these goals can consume large amounts of resources, both human and financial. The following provides a perspective on how countries in North America-the United States, Canada, and Mexico-deal with these challenges and care for patients requiring LTMV. The focus will be on the care of adult patients, but pediatric LTMV issues overlap those of adults, and some comments will be made on them as well.
