[Initiation and management of home mechanical ventilation]

Effective initiation and optimal monitoring of treatment are essential elements for successful home mechanical ventilation (HMV).

Ventilation is best initiated in a hospital setting. There is an enormous range of equipment available but there is little evidence pointing to the superiority of one device over another. Many problems can arise that lead to an interruption in HMV but often these can be resolved simply as discussed in this article.

Unfortunately a number of pitfalls in management remain, the main one being the absence of accurate data about the sleep of patients on ventilators, which hinders optimal nocturnal management. Another problem is the lack of adaptation of equipment for use by handicapped patients. Finally the transfer of responsibility and workload to home carers including family members with disengagement by the hospital can also be a major milestone.

Successful initiation and supervision is the key to effective home mechanical ventilation. Treatment is often abandoned because of pitfalls, mistakes and lack of knowledge. This article proposes means to improve these two important areas.