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When selecting an HCV, clinicians depend on patient experience and the outcomes of observational trials.
FREMONT, CA: Mechanical ventilation, administered either invasively through a tracheotomy tube or non-invasively through a mask, is progressively used for long-term treatment of many types of serious chronic respiratory failure at home. In recent years, the efficiency of ventilators for long-term home mechanical ventilation has improved significantly, and, at the same time, the number of devices available has also increased. This more comprehensive variety of commercially available machines is advantageous; however, it is more challenging to select the right system for a particular patient.
A wide variety of Home Care Ventilators (HCVs) are also available for long-term mechanical ventilation. HCVs are heterogeneous in terms of technological performance and reliability, and user-friendliness for the operator. However, this wide variety of commercially available machines makes it more difficult to select the right device for various patients. Furthermore, manufacturers also suggest new ventilation modes, but, as in acute critical care environments, there is also a lack of empirical evidence of their efficacy and clinical benefit.
When selecting an HCV, clinicians depend on patient experience and the outcomes of observational trials. Ideally, the method of choosing a ventilator should be based on a sound scientific argument based on predetermined criteria and ratings, as in the field of critical care. Since the manufacturer's own requirements are minimal, they should not be a central factor in the decision-making process. Essential awareness of the concepts of the operation of the ventilator can be helpful when selecting an HCV. This aspect allows the physician or respiratory therapist to assess the HCV's technical performance concerning the patient's clinical characteristics and the underlying condition, the home care environment, and the financial resources available.
HCV's choice should be based on basic knowledge of machine-specific mechanisms and an understanding of physiological rationale. It is necessary to consider how these functions interact with the operating environment and the needs of patients. If this goal has been accomplished, the ventilator can be selected based on individual needs (in particular, whether protection or comfort is the most critical factor), restrictions, and costs.
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