[The introduction of home mechanical ventilation in Japan]

In the same context as home oxygen therapy in Japan, there is an urgent need to establish a home mechanical ventilation (HMV) support system for clinically stable patients dependent on long-term mechanical ventilation who wish to spend their lives outside institutions; at home in the community. We have cared for 3 HMV cases as long as 8, 5 and 2 years. All patients suffer from respiratory muscle paralysis with chronic neuromuscular diseases and require CMV mode mechanical ventilation for 18 to 24 hours/day using electrically drived portable ventilators connected to a tracheostomy tube. They need no oxygen supplementation. All patients clearly expressed a desire for the life style with HMV. Their families as the main caregivers willingly received the necessary training and mastered the techniques quickly, including AMBU-bag manual ventilation for occasional ventilator troubles, and bronchial hygiene. Our experiences of three HMV cases may be local and limited, but reveal the potential significance and technological possibility for home application of the care techniques that have been developed on or in-patient basis. The nationwide surveys of the status of patients requiring long-term mechanical ventilation for more than 3 months of duration by Suetsugu et al. (supported by Respiratory Failure Research Council of Health and Welfare Ministry) (1987, 1988 and 1989) listed 53 HMV cases in 1989 and revealed a slowly increasing trend from the 17 cases in 1987. However, it is important to recognize that the true medicosocial establishment of HMV in Japan is still behind and should be an urgent goal of respiratory care programs.(ABSTRACT TRUNCATED AT 250 WORDS)