Long-Term Management of Ventilator-Assisted Individuals: The Boston University Experience

Abstract

In the 4½ years beginning in January 1981, the University Hospital at the Boston University Medical Center admitted 46 ventilator-assisted individuals to its Respiratory Care Center and discharged 38 of them to their homes with ventilators. Of the 46 admitted, 23 had COPD and 23 had neuromuscular or skeletal disorders. All the latter were successfully sent home, and 15 of the 23 with COPD went home. At follow-up in 1985, of the 38 patients managed at home for periods of 1 to 51 months, 30 were surviving and 4 with COPD and 4 with neuromuscular disorders had died. One died immediately after discharge, one who had amyotrophic lateral sclerosis lived 9 months at home before dying, and the other 6 lived at home a year or more before dying. These results were made possible by an inpatient facility that had the goal of improving the quality of life of ventilator-assisted persons. This was done by the use of portable ventilators on motorized wheelchairs, by the use of traditional rehabilitation techniques, and by encouraging and training patients to become independent and responsible for their own personal and respiratory care. The hospital-based Respiratory Care Center is staffed by a team from physical therapy, occupational therapy, respiratory therapy, rehabilitation nursing, social service, psychiatry, rehabilitation medicine, and otolaryngology. A pulmonary physician directs the program and a respiratory nurse specialist is co-director and oversees its daily operation. The rehabilitation process has six stages: Stage I is stabilization, Stage II is evaluation, Stage III is rehabilitation planning, Stage IV is rehabilitation training, Stage V is discharge planning, and Stage VI is post-discharge care. The Boston University experience suggests that the prognosis for ventilator-assisted persons in the home is good.