Home mechanical ventilation: investigation of 34 cases in Taiwan

To evaluate the characteristics of and acceptance by persons in Taiwan who currently use positive-pressure mechanical ventilation at home (HMV), a survey was conducted in August 1992 through home care and equipment providers to investigate these patients. The 34 cases enrolled, including 18 males and 16 females, were classified into four groups: (1) lung disease group (LD) (n = 7) including chronic obstructive pulmonary disease and bronchiectasis; (2) neuromuscular group (NM) (n = 14) including diverse neuromuscular diseases; (3) spinal disease group (SP) (n = 7) including spinal cord injuries or tumors and (4) unresponsive stroke group (US) (n = 6). The average age of the SP group was much younger than those of the other three groups. The duration of home ventilation was from 1 to 36 months, with a mean duration of 10.6 +/- 8.7 months. Fifteen cases had received HMV for more than one year. Twenty six (76.5%) of the patients were completely dependent. All of the US patients had to be ventilated all day long in contrast to 71.4% of LD completely dependent. The cost of the US group was higher than that of the other three groups. Two of the LD, five of NM and one US patient had been re-admitted because of pneumonia, tracheostomy wound infection, granulation formation or weaning problems before the study. A follow-up survey was done four months, then one year later. The survival rate was 16.7% for LD group, 50% for NM and US group. Of the SP group, all patients were surviving at the end of this study. Most of the present HMV users were satisfied with their setting. It was concluded that HMV is an acceptable alternative way of therapy for long-term ventilation patients in Taiwan. SP and NM patients are better candidates for HMV. The overall one year survival rate is promising, while SP patients had the best prognosis. Patients who had already used HMV for more than 11 months, regardless of the disease, have a better chance to live another year.