Ventilator-Assisted Living©

February 2014, Vol. 28, No. 1

 

Pfrommer lecture: 

Ventilator-Assisted Individuals;
Integrating Across the Spectrum of Care

Dr. Roger S. Goldstein, Director Respiratory Medicine and Senior Scientist, West Park Healthcare Centre, Toronto, Ontario, Canada

Between 1850 and 1950, negative pressure ventilators, rocking beds, cuirass shells and iron lungs were developed. The latter proved lifesaving during the polio epidemics in the mid-1950s. Subsequently positive pressure ventilators (invasive and noninvasive) as well as interfaces (tracheostomy, face mask, nasal pillows) came into being. The growing prevalence of long-term mechanical ventilation (LTMV) is associated with increased survival following a life-threatening episode, increased technology in the intensive care unit (ICU) and greater awareness of individuals whose underlying condition progresses naturally to cardiorespiratory failure so that elective ventilatory support may be initiated.

The spectrum of care for ventilator-assisted individuals (VAI) varies from the ICU (highest acuity of illness and highest intensity of care), to home (lowest acuity and lowest intensity of care). Between these two points there are non-acute assisted ventilatory care units, in-patient rehabilitation units, skilled nursing facilities and assisted living centers, each of which is designed to offer a safe setting for the VAI, preferably with a rehabilitative environment to promote autonomy and self-directed care.

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