Chest
Volume 86, Issue 3, September 1984, Pages 358-365
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Clinical Investigations
Rehabilitation of Ventilator-Dependent Subjects with Lung Diseases: The Concept and Initial Experience

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Sixteen ventilator-dependent patients were enrolled in an in-patient pulmonary rehabilitation (PR) program in a university medical center with the goals of achieving independent self-care, mobility and discharge home. Ten patients had chronic obstructive pulmonary disease and six had restrictive respiratory disorders. PR by a multi-disciplinary team consisted of five phases: 1) stabilization; 2) evaluation; 3) rehabilitation planning including motivation by allowing speech and mobility; 4) rehabilitation training encouraging independent performance of activities of daily living (ADL); and 5) discharge planning with training of patients and families in home respiratory care techniques. A key aspect of the program is improving independence early in the program through the use of mobile ventilators. Periods of weaning from ventilatory support for two or more hours per day were of great importance in improving patient mobility and independence in ADL. Twelve patients were discharged home; except for two individuals who were severely limited by neuromuscular disease, all patients were largely independent in ADL in the home. This preliminary report demonstrates the feasibility of training ventilator-dependent persons to be independent and to participate in their own care in the home.

Section snippets

METHODS

In January, 1981, an inpatient unit devoted to the rehabilitation of ventilator-dependent persons and called the Respiratory Care Center (RCC), opened at University Hospital, Boston, MA. The unit is located on a floor dedicated to the rehabilitation of patients with neurologic and musculoskeletal conditions. This floor is equipped with wheelchair roll-in showers and bathrooms, a physical therapy exercise room, a recreation room, an occupational therapy training facility with a kitchen and

Patient Characteristics

Sixteen ventilator-dependent patients (Table 1) were discharged from the RCC from its inception in January 1981, through November, 1982; two patients were admitted twice during this period. The patients were divided into two groups based upon the nature of their pulmonary disease: group 1 with COPD, and group 2 with restrictive disorders.

The ten patients in group 1 had been hospitalized in other acute care settings for an average of 148 days prior to admission to the rehabilitation program.

DISCUSSION

Our experience indicates that not only can ventilator-dependent persons be discharged from the hospital and cared for in their homes, but also that these individuals can be mobile, functional, and retain a good deal of independence. Although it is well known that patients with neuromuscular and chest wall diseases can successfully receive ventilatory support in the home,8 there has been mixed success in the home care of ventilator-dependent persons with COPD. Sivak et al8 reported sending four

ACKNOWLEDGMENT

S: The authors wish to express their gratitude to the staff of the Respiratory Care Center for their dedication, the administration of University Hospital for its continuing support of the RCC, and Ms. Laurie Beardsley for her excellent secretarial assistance.

References (16)

  • DA Fischer et al.

    Feasibility of home care for certain respiratory-dependent restrictive or obstructive lung disease patients

    Chest

    (1982)
  • H Pontoppidan et al.

    Respiratory intensive care

    Anesthesiology

    (1977)
  • D Munro

    The rehabilitation of patients totally paralyzed below the waist, with special reference to making them ambulatory and capable of earning their own living. V. An end-result study of 445 cases

    N Engl J Med

    (1954)
  • SH Berns et al.

    Spinal cord injury—rehabilitation costs and results and follow-up in thirty-one cases

    JAMA

    (1957)
  • M Gilmartin et al.

    Ventilator-dependent persons can speak!

    Am Rev Respir Dis

    (1983)
  • M Gilmartin et al.

    Home care of ventilator-dependent persons

    Respir Care

    (1983)
There are more references available in the full text version of this article.

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Presented in part at the American Thoracic Society Annual Meeting, May 1982, Los Angeles, CA and published in abstract form in the Am Rev Respir Dis 1982; 125(suppl 2):139.

Manuscript received December 11; revision accepted February 16.

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