OPTIONS FOR LONG-TERM VENTILATORY SUPPORT

A number of acute and chronic conditions can lead to the development o f chronic ventilatory failure, requiring long-term ventilatory support with a mechanical ventilator. The most commonly encountered reasons f or such support may include chronic lung diseases, especially chronic obstructive lung disease (COPD); acute and chronic neuromuscular disea ses; catastrophic medical. or surgical illnesses; surgery in high-risk patients; and trauma. It is usually possible to liberate patients fro m a ventilator in the acute hospital setting. A significant number of patients, however, remain dependent upon mechanical ventilation for a considerable period after its initiation. Whatever the cause, long-ter m mechanical ventilator dependence may be required when it is impossib le for an individual to maintain adequate alveolar ventilation without assistance either to survive or, in some, to function with an accepta ble quality of life. Depending upon the degree to which normal alveola r ventilation is compromised, patients may need continuous or partial mechanical ventilatory support. For most patients in the latter situat ion, nocturnal mechanical ventilation is used to make it possible for them to function without mechanical support during the day. Unfortunat ely, a certain number of individuals require full-time mechanical vent ilation, which has a limited number of options regarding the safest wa y to sustain it.