Analysis of home support and ventilator malfunction in 1,211 ventilator-dependent patients

Abstract

Risk management is an important aspect of home ventilation (HV). We examined the nature of calls to a home support helpline to identify patient/equipment problems and strategies to minimise risk for patients, healthcare teams and manufacturers.From 1,211 adult and paediatric patients with neuromuscular disease, chronic obstructive pulmonary disease or chest wall disease receiving HV, all calls to a dedicated respiratory support telephone hotline between January 1, 2006 and June 30, 2006 were analysed.1,199 patients received noninvasive ventilation, 12 tracheostomy ventilation; 149 had two ventilators for 24-h ventilator dependency. There was a mean of 528 daytime calls per month and 14 calls a month at night. Following 188 calls, a home visit was performed; these identified a technical problem that could either be solved in the patient's home in 64% or required replacement or new parts in 22% of cases. In 25 calls in which no mechanical fault was identified, 13 patients were either found to be unwell or required hospital admission.Patients using HV have a substantial requirement for assistance, with most technical problems being resolved simply. Where no fault can be found during an equipment check, the patient themselves may be unwell and should receive early clinical evaluation. The patient may have mistaken clinical deterioration for an equipment problem.

Home Mechanical Ventilation in Canada: A National Survey

“…24 Issues relating to ventilator equipment failure are not infrequent. In the United Kingdom, Chatwin and colleagues 25 reported on 1,211 ventilator-assisted individuals receiving NIV over a 6-month time frame and found an 8% failure rate per NIV device manufacturer, with higher failure rates in highly ventilator-dependent individuals and older devices. An earlier study of mostly tracheostomized ventilatorassisted individuals reported 189 equipment-associated issues in 150 users over 1 y and found that 43% were due to improper use or care of equipment by caregivers.…”

Home ventilation: need a user support number?

“…In the present issue of the European Respiratory Journal, CHATWIN et al [1] present data on the call centre they established to support more than 1,000 patients on home respirators. The Respiratory Unit of the Royal Brompton Hospital (London, UK) serves a vast geographical area.…”

“…These calls can be made for a number of reasons; from simple concerns such as asking for spare part replacement, to more disturbing ones such alarms coming on during the night or to a respirator becoming noisy all of a sudden, to very serious ones such as a respirator breakdown in a respirator dependent patient. CHATWIN et al [1] have recorded and analysed all calls received during a 6-month period, from a population of 1,211 patients, from paediatrics to geriatrics, who were followed up at their centre. All patients had had a training process within the Royal Brompton Hospital unit, and all patients or families were deemed able to understand the use of home respirators, adequately fit and assembly/disassembly the mask and interfaces, start and stop the machines, and even to unlock the settings in order to change them according to telephonic instructions if this was thought useful by the on-call personnel.…”

“…In 25 visits, no faulty equipment was identified, and 13 of these 25 patients had had a change in their medical condition or required hospital admission. When investigating respirator breakdowns, CHATWIN et al [1] found an increased malfunction rate in older respirators that had served for .8 yrs, as well as in new respirators on the market. There was also a high breakdown rate in highly dependent patients who used respirators for .16 h per day.…”

“…Many of the characteristics of the system implemented by CHATWIN et al [1] depend on their particular practice, with a large geographic area to cover. In other circumstances, as is the case in our laboratory, the personnel of the centre could accompany the patients on the first day of home ventilation to verify the placing of the respirator in the bedroom, the availability of electrical connections, the level of autonomy of the patients and family to place the mask interface and so on [2].…”