Vol. 11 •Issue 8 • Page 78
Lightweight Ventilator Eases Transition from Hospital to Home
Ease of use, portability and state-of-the-art technology are important features to consider when choosing a mechanical ventilator for the home setting.
The preferred ventilator would incorporate volume and pressure control, pressure support, adjustable inspiratory and expiratory flow criteria, and a comprehensive monitoring and alarm system, yet it would be portable and easy for the lay caregiver to operate. The lightweight, laptop-size LTV™ 950 ventilator manufactured by Pulmonetic Systems Inc., Colton, Calif., offers all of these features, and it can be used with adult and pediatric patients.
This case study involves a 6-year-old girl with a diagnosis of medullary tumor, which was surgically removed, and central sleep apnea. At the time of initiation of mechanical ventilation, the patient was otherwise a healthy and very active little girl. She had a tracheostomy tube inserted to facilitate the connection of the mechanical ventilator and for bronchial hygiene. Her prognosis was good, and her short-term goal was to start attending school.
Because the patient would be making frequent 100-mile trips to various physician visits in Dallas, it was very important for her to have a ventilator that was lightweight and portable, had a comprehensive alarm and monitoring system, and had an adequate internal and external DC power supply.
The patient had been using a LTV™ 1000 ventilator by Pulmonetic Systems while she was in the hospital, so the transition to the LTV 950 was very easy for the patient, staff and family caregivers. Both LTV models are essentially the same except for the internal oxygen blender in the LTV 1000.
Home health nurses and family caregivers seemed to quickly learn the basic operation and troubleshooting of the ventilator.
The initial ventilator settings on the LTV 950 were set the same as the hospital ventilator: tidal volume of 300 mL, pressure support of 15 cmH2O, PEEP of .5 cmH2O; inspired time of 0.8 seconds; rise time profile of 4; flow termination of 25 percent; sensitivity of 3 liters per minute; apnea interval of 20 seconds; and FIO2 of 0.21. The patient’s SpO2 remained at 97 percent to 98 percent when transitioned to the LTV 950 from the LTV 1000.
The patient was discharged to home one week later. Her parents were comfortable enough with the LTV that they didn’t even feel the need for a respiratory therapist to accompany them home. After the patient arrived home, the RT made a visit to ensure that all of the equipment was set up properly. Thereafter, he made routine monthly visits.
No significant problems occurred during the course of this patient’s home ventilator care. The patient was weaned gradually from the ventilator, her tracheostomy tube was removed, and she was placed on noninvasive bilevel ventilation via nasal mask, which she tolerated well. The patient was able to start attending school prior to weaning off the LTV, about three months after discharge from the hospital to home.
The LTV 950 offered the following advantages not available with most other home ventilators:
• very portable (weighs only 12.5 pounds)
• external power supply (three or nine-hour external battery, DC adapter for use in the car, internal battery that lasts 1 hour to 1.5 hours)
• continuous flow; flow triggering
• pressure support
• adjustable rise time and flow termination
• high and low pressure alarms
• low minute volume alarm
• apnea back-up ventilation feature with adjustable apnea interval.
The advantages of the LTV far outweigh the disadvantages. It’s worth the slightly higher cost than you would pay for a bulky ventilator that doesn’t offer continuous flow, pressure support, adjustable rise time or flow termination, or a comprehensive monitoring and alarm package. In summary, the LTV 950 was the ideal choice of home ventilator for this patient.
Barch is owner/president of Pulmonary Care Management Solutions (PCMS), Arlington, Texas, and is partner/clinical services director for Life Support Systems Home Ventilator Program, Ft. Worth, Texas.