Ventilator-Assisted Living©

Summer 2004, Vol. 18, No. 2

(continued)

Home Mechanical Ventilation
in Brazil Revisited

Luiz Gustavo Ghion, PT, and Walmar Augusto Miranda, MD
Home Doctor, São Paulo, Brazil

Home mechanical ventilation (HMV) has been a reality in Brazil since 1994 when home care companies began in São Paulo (see IVUN News, Vol. 15. No. 4, Winter 2001). Before that, only a few people used HMV, and the cost of the treatment was covered privately by the individual's family. If the person's family did not have enough money, the person remained in the hospital indefinitely, even with a stable clinical condition.

In Brazil home care is available only for people who have private insurance (about 28% of the entire population). Public programs to help less wealthy people using HMV are just beginning.

Home care provides the equipment, an auxiliary nurse 24/7, daily physiotherapy and respiratory care, and twice-weekly physician's visits. Home Doctor is one of the largest private home care companies in São Paulo with an HMV program. Currently the program follows 52 people, half adults and half children. Most of the people using HMV have neuromuscular disease; others are neurological and pulmonary patients.

Noninvasive ventilation (NIV) is used in Brazil by people with neuromuscular diseases and COPD, and sometimes during the weaning process. Home Doctor handles only a few NIV cases; most people use tracheostomy positive pressure ventilation. People with obstructive sleep apnea (OSA) use CPAP units, but they are not managed by home care companies.

Parents and caregivers are trained in suctioning and use of the ventilators, but with 24-hour nursing and daily physical therapy, they usually do not perform the care themselves.

Due to cultural beliefs and intellectual levels, some of the families refuse to learn or to perform some procedures; they believe that a health professional should do it for them. Some families and caregivers prefer that their ventilator user remain in the hospital instead of at home, either because they do not want to provide any care or because they cannot afford the higher electrical bills and other expenses of home care.

Success for Twins photo of the twins and their mother

A year and a half ago, an insurance company contacted Home Doctor to assess a set of twins diagnosed with a nonspecific myopathy and dependent on tracheostomy positive pressure ventilation. At that time the twin boys, Matheus and David, were seven months old, and both were being ventilated with a Sechrist hospital ventilator in the Pediatric Intensive Care Unit (PICU). They also needed oxygen due to a recurrent atelectasis associated with pneumonia during their hospital stay.

The first step in going home was to start them with the LTV1000™ (Pulmonetic Systems, Inc.) during an adaptation period inside the PICU. At the same time an assessment in their home was performed, and electrical modifications were made to accommodate the electrical requirements of all the equipment the boys would need, including the ventilators, suction machines, oximeters, universal power system, etc.

After two weeks, the twins' adaptation to the LTV1000 was judged a success and they went home. Although the routine of the boys' parents completely changed, they are very happy to have their children home.

Now Matheus and David are 2 years and 4 months older. They use the LTV950™ ventilator, but they no longer need supplemental oxygen. During their time at home, the boys have required no hospitalization, and the parents are pleased with their sons' progress.

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