Consensus Statements

Mechanical Ventilation: Beyond the ICU
Quick Reference Guide

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Equipment and Resources

Ventilators typically used in the ICU are not recommended for use in the long-term setting. Only ventilators specifically designed for home use should be employed in the home. Creating an ICU environment in the home is not desirable.

The synchronized intermittent mandatory ventilation (SIMV) mode on home care ventilators is not recommended without modification of the gas delivery system with a one-way valve in the inspiratory limb to allow inspiration from the atmosphere.

For patients requiring only nocturnal ventilatory assistance,

• simple bilevel pressure-targeted assist devices are recommended.

For patients requiring continuous ventilatory support,

• more sophisticated volume-limited ventilators are recommended.

If invasive ventilation is necessary,

• a portable volume-targeted ventilator in the assist/control mode is recommended.

In the event of power disconnect or ventilator malfunction, a disconnect alarm should be used at all times;

• a backup ventilator with fully charged power source should be available within 20 min;
• in the long-term setting, including the home, a 12-volt battery should be available when power outages are common (batteries should be checked for full charge on a regular weekly basis); and
• in rural areas where power outages may be prolonged, a backup electrical generator should be available and regularly operated to assure readiness on demand.

• Humidification

All patients receiving continuous mechanical ventilation via tracheostomy require humidification of inspired air:

• Water reservoir type humidifiers are more effective than heat and moisture exchangers.
• Heat and moisture exchangers may be used for periods <12 hours—eg, on a trip—but are not recommended for patients on noninvasive ventilation.
• Humidification is not required for most patients using noninvasive or mask ventilation but may be needed in dry climates, during low-humidity winter months, or for patients using lipseal or mouthpiece ventilation.

• Supplemental Oxygen

Need for supplemental oxygen during long-term support should be established by arterial blood gas analysis, with monthly monitoring of SaO₂ by pulse oximetry.

• Patient Communication System

A reliable system should be established to allow the patient to communicate regularly and at will.

Systems range from an uncuffed tracheostomy tube and one-way speaking valve, to a bedside computer.

An emergency signal should be readily available for the patient's use.

• Suctioning

Caregivers should be trained in the use of equipment to suction the patient's airway by sterile technique.

• Durable Medical Equipment

DME maintenance and emergency service must be available 24 h a day.

A backup ventilator must be available for emergency use.

• Transportation

A reliable and safe wheelchair accessible method should be available to transport the patient and the patient's ventilation equipment.

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