Home mechanical ventilation: a Canadian Thoracic Society clinical practice guideline

Abstract

Increasing numbers of patients are surviving episodes of prolonged mechanical ventilation or benefitting from the recent availability of userfriendly noninvasive ventilators. Although many publications pertaining to specific aspects of home mechanical ventilation (HMV) exist, very few comprehensive guidelines that bring together all of the current literature on patients at risk for or using mechanical ventilatory support are available. The Canadian Thoracic Society HMV Guideline Committee has reviewed the available English literature on topics related to HMV in adults, and completed a detailed guideline that will help standardize and improve the assessment and management of individuals requiring noninvasive or invasive HMV. The guideline provides a disease-specific review of illnesses including amyotrophic lateral sclerosis, spinal cord injury, muscular dystrophies, myotonic dystrophy, kyphoscoliosis, post-polio syndrome, central hypoventilation syndrome, obesity hypoventilation syndrome, and chronic obstructive pulmonary disease as well as important common themes such as airway clearance and the process of transition to home. The guidelines have been extensively reviewed by international experts, allied health professionals and target audiences. They will be updated on a regular basis to incorporate any new information.

Figure 1-1)

Flow volume loops of individuals with kyphoscoliosis (post-polio) (A) and tetraplegia (B). Spontaneous vital capacity (red) and maximum insufflation capacity with lung volume recruitment (blue)

Figure 1-2)

Flow diagram for preventive airway clearance techniques. LVR Lung volume recruitment; PCF Peak cough flow. *Philips Healthcare, USA