[Long-term mechanical ventilation in Japan, with special reference to home mechanical ventilation]

Some patients in respiratory care units are difficult to wean from mechanical ventilation, and may be candidates for home mechanical ventilation (HMV). HMV may improve these patients' quality of life and decrease medical expenses. Since 1987, six nationwide questionnaire surveys were done to study the status of long-term mechanical ventilation (defined as mechanical ventilation for at least 90 days) and HMV in Japan. In 1994, an additional questionnaire regarding opinions about HMV was sent to physicians, patients undergoing HMV, their families, and people in companies that deal with home ventilators. From 1987 to 1994, the number of patients who had been mechanically ventilated for at least 90 days increased from 368 to 956. According to the 1994 survey, 565 of those patients were not candidates for HMV, 235 of them were candidates for HMV but could not be shifted (reasons are given below), and 156 were shifted to HMV. The reasons that some patients who were considered to be candidates for HMV could not be shifted included a lack of caregivers at home (58.1%), the cost of a ventilator (44.5%), lack of proper health insurance (39.8%), problems with ventilator maintenance and delays in obtaining repairs (37.7%), and inadequacies in the system for providing medical care in the home (33.1%). Despite the problems entailed in shifting to HMV, many patients undergoing HMV (77.8%) and members of their families (83.3%) expressed a desire to continue this therapy. Many physicians (94.0%) said they believed that HMV improves the quality of life of patients with chronic respiratory failure. Some companies intend to begin renting ventilators for HMV. The use and development of HMV in Japan would be promoted if the national health insurance covered the costs of this therapy.