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Frequency, Causes, and Outcome of Home Ventilator Failure FREE TO VIEW

Saumini Srinivasan; Sharon M. Doty; Tanya R. White; Victor H. Segura; Mary T. Jansen; Sally L. Davidson Ward; Thomas G. Keens
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Affiliations: From the Division of Pediatric Pulmonology, Childrens Hospital Los Angeles, University of Southern California School of Medicine, Los Angeles, CA,  From the Greater Los Angeles Branch, NMC Homecare, Pasadena, CA.

Thomas G. Keens, MD, Division of Pediatric Pulmonology, Childrens Hospital Los Angeles, 4650 Sunset Blvd, MS No. 83, Los Angeles, CA 90027; e-mail: keens@chla.usc.edu

1998 by the American College of Chest Physicians

Chest. 1998;114(5):1363-1367. doi:10.1378/chest.114.5.1363
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Study objectives: The safety of home ventilators has been questioned. We collected data to study the following: frequency of home ventilator failure, apparent causes for the failure or malfunc ¬ tion, and adverse consequences following the failure.

Study design: Information on all requests to correct home ventilator failures reported to a home respiratory equipment vendor was collected prospectively between November 1991, and November 1992.

Patients: There were 150 ventilator-assisted patients aged 2 to 77 years; 44 were ≤ 18 years. They received 841,234 h of home mechanical ventilation (average, 15.4 h/d per ventilator-assisted patient).

Results: There were 189 reports of home ventilator failure. Defective equipment or mechanical failure was found in only 39% (73 reports), equivalent to one home ventilator failure for every 1.25 years of continuous use. Other causes of ventilator failure included the following: improper care, damage, or tampering with the ventilator by caregivers (13%), functional equipment improperly used by caregivers (30%), and equipment functional but the patient's condition changed, mimicking ventilator failure (3%). No problem could be identified in 16%. The following actions were required: ventilator replacement (44%), repair of a defective part (6%), replacement of a functioning ventilator for psychological comfort (14%), ventilator adjustments made (21%), caregiver reeducation (7%), caregiver anxiety or distress reduced (3%), and no action required (4%). Hospitalization was required only in two cases (1%). No adverse outcomes, deaths, or serious injuries were associated with home ventilator failure.

Conclusions: We conclude that in 150 patients requiring home mechanical ventilation, ventilator failure occurred relatively infrequently, and there were no adverse outcomes as a result of equipment failure at home. We speculate that equipment failure is not a frequent or serious problem for ventilator-assisted patients treated at home.




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