Chest
Clinical InvestigationsRehabilitation of Ventilator-Dependent Subjects with Lung Diseases: The Concept and Initial Experience
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.
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Cited by (42)
Bilevel ventilation during exercise in acute on chronic respiratory failure: A preliminary study
2010, Respiratory MedicineCitation Excerpt :Non-invasive ventilation during exercise has been shown to reduce dyspnoea in proportion to respiratory muscle unloading,9,10 improve gas exchange,11–13 and increase endurance time compared to unassisted exercise in patients with chronic HRF secondary to severe COPD3,11 and severe restrictive chest wall disorders.14–16 While invasive mechanical ventilation during walking has been described in stable hospitalised ventilator-dependent patients8,17,18 and during supported arm exercise (SAE) in difficult to wean patients with COPD and HRF,19 the effect of non-invasive ventilation plus oxygen (NIV + O2) during walking or during functional (unsupported) arm exercise compared to standard therapy (exercise with O2 alone) is unknown in patients recovering from acute on chronic HRF. If NIV + O2 during exercise can provide similar benefits to patients recovering from acute HRF as in stable patients with HRF, it may permit exercise rehabilitation to be commenced earlier in the hospital stay, thus reducing the risk of further deconditioning.
The role of physiotherapy in the management of COPD
2008, Respiratory Medicine: COPD UpdateSupported arm training in patients recently weaned from mechanical ventilation
2005, ChestCitation Excerpt :Moreover, there is no evidence that limb exercises prevent loss of joint range or increase muscle strength and function.22 To date, there are few controlled studies assessing the role of PRPs including exercise training in patients recovering from a severe episode of acute ventilatory insufficiency requiring short-term or long-term MV.3031 In a prospective randomized study, Nava13 showed the efficacy of a PRP including exercise training in patients with severe COPD recovering from a severe episode of ARF; however, not the whole of the patients included in this study had required MV, and most of them had already been discharged from the weaning center at the moment of their entry into the study.
Chronic ventilator dependence in elderly patients
2000, Clinics in Geriatric MedicineCitation Excerpt :From a patient care perspective, the ICU environment is ill-suited to provide privacy, rest, and physical rehabilitation for long-staying patients. The principles of pulmonary rehabilitation have been shown to liberate some patients from prolonged ventilator use.42 Furthermore, ICU personnel oriented to aggressive life-support and diagnostic efforts experience frustration at the slow progress of patients and when critical care resources are unavailable for urgent care of the newly critically ill.27
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.