Acute Crit Care.  2020 Aug;35(3):131-141. 10.4266/acc.2020.00514.

Home mechanical ventilation: back to basics

• Park S
• Suh ES

• KMID: 2506091
• DOI: http://doi.org/10.4266/acc.2020.00514

Abstract

Over recent decades, the use of home mechanical ventilation (HMV) has steadily increased worldwide, with varying prevalence in different countries. The key indication for HMV is chronic respiratory failure with alveolar hypoventilation (e.g., neuromuscular and chest wall disease, obstructive airway diseases, and obesity-related respiratory failure). Most modern home ventilators are pressure-targeted and have sophisticated modes, alarms, and graphics, thereby facilitating optimization of the ventilator settings. However, different ventilators have different algorithms for tidal volume estimation and leak compensation, and there are also several different circuit configurations. Hence, a basic understanding of the fundamentals of HMV is of paramount importance to healthcare workers taking care of patients with HMV. When choosing a home ventilator, they should take into account many factors, including the current condition and prognosis of the primary disease, the patient’s daily performance status, time (hr/day) needed for ventilator support, family support, and financial costs. In this review, to help readers understand the basic concepts of HMV use, we describe the indications for HMV and the factors that influence successful delivery, including interface, circuits, ventilator accessories, and the ventilator itself.

Keyword

basic; home; mechanical; ventilators

Figure

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  Figure 1. Diagram of V60 (Philips Respironics), which is a dedicated critical care noninvasive ventilator. This ventilator has a blower and single-limb vented circuit.

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  Figure 2. Three circuit configurations. (A) A single-limb vented circuit (with a leak port). (B) A single-limb non-vented circuit (with an active exhalation valve). (C) A double-limb circuit. PEEP: positive end-expiratory pressure; PAP: proximal airway pressure.

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  Figure 3. Trigger and cycle sensitivity. (A) Trigger sensitivity: the higher the trigger sensitivity (or a lower absolute threshold value), the faster the breath initiation. (B) Cycle sensitivity: the higher the cycle sensitivity (i.e., a higher percentage of peak inspiratory flow), the faster the termination of the inspiratory phase. The X-axis indicates time (sec) and the Y-axis denotes flow (L/min).

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  Figure 4. Rise time. The X-axis indicates time (sec) and the Y-axis denotes pressure (cm H2O).

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