The home ventilation is a branch of intensive care , in which patients due to temporary or permanent disorders of nervous system or respiratory muscles mechanically ventilated are, but they were nevertheless released from the hospital. A distinction is made between invasive and non-invasive ventilation.
Forms of ventilation
With invasive ventilation , the patient is ventilated through a tracheal cannula that is placed through the neck directly in the trachea (windpipe) . Invasive ventilation is usually carried out continuously, but can sometimes be suspended for up to several hours as long as the patient tolerates it.
With non-invasive ventilation (NIV - non-invasive ventilation), ventilation is not carried out through tubes or tracheostomy tubes , but special, partly custom-made masks are used. With the NIV there are practically always large leaks because the masks do not close exactly. Therefore, the NIV is usually only used for intermittent ventilation.
There is also the option of non-invasive ventilation using cuirass ventilation . In doing so, positive and negative pressure are alternately applied to the patient's thorax and abdomen. Due to the changing volume in the chest and thus in the lungs, air is passively inhaled and exhaled. This procedure can v. a. be used for weak muscles in the respiratory muscles, such as B. in spinal muscular atrophies .
Handy and comparatively user-friendly ventilators are used for home ventilation (e.g. in the context of so-called home care areas) . Depending on the ventilation selected, ventilation takes place either through a ventilation mask or through a tracheostomy tube in the tracheostoma .
Care for home ventilation
Since such intensive medical treatments at home may overwhelm the relatives of the patients and the time requirements for outpatient care are not sufficient, there are care services that specialize in home ventilation or home intensive care .
For home-ventilated patients, the health insurance usually approves a certain number of hours (up to 24 hours a day) that are covered by the nursing service. During this time, a nurse is present not only to carry out basic and treatment care , but also to react quickly with the appropriate measures in the event of sudden complications.
Each patient requiring ventilation should at least have:
- an emergency kit to replace the tracheostomy tube
- an extractor and a stand-alone replacement device
- an oxygen concentrator and an oxygen cylinder or liquid oxygen for power outages
- in individual cases a pulse oximeter
- a resuscitator to be prepared for failure of the ventilator
- The indication for a second ventilator is given if the daily ventilation duration is more than 16 hours.
Because of this and any other devices (such as accessories for the PEG , nursing care bed ), consumables, but above all because of the outpatient care by nursing staff, home-ventilated patients are expensive for the health insurers, but cheaper than if they were in the hospital in an intensive care unit .
Typical clinical pictures
Typical clinical pictures in home ventilation are:
- Amyotrophic lateral sclerosis (ALS)
- Muscular dystrophy
- Guillain-Barré Syndrome (GBS)
- Chronic obstructive pulmonary disease (COPD)
- Post Polio Syndrome
- Restrictive diseases such as post-TBC syndrome, pulmonary framework disease, kyphoscoliosis ethorax
- Georg Thieme Verlag KG: Non-invasive and invasive ventilation as a therapy for chronic respiratory insufficiency ( Memento from January 9, 2016 in the Internet Archive ), Pneumology 2010; 64 (4): 207-240, DOI: 10.1055 / s-0029-1243978