Outcome of home mechanical ventilation

Objective: To determine the outcome of patients discharged home on portable ventilator. Design: Descriptive study. Place and duration of study: The Aga Khan University Hospital, Karachi from January 2000 to December 2004. Patients and methods: All ventilator-dependent patients discharged home were contacted. Survivors were administered the EQ-5D Quality-of-Life instrument. SPSS version 13 was used to analyze data. Results: Eleven patients were discharged home on invasive ventilation. Mean age was 49 years (range 10-98 years). Cause of ventilatory failure were cervical spine trauma in 36%, primary neurological disease in 27%, critical illness neuropathy and respiratory failure in 18% each. Survival rate was 73%, with three deaths. Mean duration of ventilation was 9.45 months (95% CI 3.24, 15.67). Rate of successful weaning after discharge was 36%, with 4 patients off all forms of ventilatory support and 2 on only nocturnal support. A 2.8 (95% CI 0.5, 16.6) relative risk towards successful weaning was associated with the presence of a family member as the primary care giver. Mean scores on the EQ-5D descriptive tool were; mobility 2 (±0.82), self-care 2 (±0.82), usual activities 1.86 (±0.69), pain/discomfort 1.43(±0.79), anxiety/depression 1.29 (±0.76). Mean score on the EQ-VAS was 48.2(±27.3). Conclusion: In carefully selected patients, home ventilation is a viable option with the expectation of successful weaning and survival. Patients discharged home on ventilation reported a reasonably good quality of life with proportionately more problems related to independence compared to overall well-being.