A study of the use of home mechanical ventilator and medical insurance

PURPOSE: Use of a home mechanical ventilator can shorten the hospitalization duration of children with chronic respiratory failure requiring long-term use of a mechanical ventilator. In this study, the researchers analyzed patients who had used a home mechanical ventilator. METHODS: From January 2009 to July 2014, we retrospectively investigated 15 patients under 18 years of age, from 2 hospitals, and their use of home mechanical ventilators. RESULTS: The median age of the patients was 55 months. Ten children were male, and 5 were female. As for the type of mechanical ventilators, 10 used a pressure type, 3 used a volume type, and 2 used a volume-mask type. Analysis of underlying diseases revealed that 10 children had neuromuscular disease, 3 had pulmonary disease, and 2 suffered from hypoxic ischemic encephalopathy. The number of patients who were discharged from the hospital with a home mechanical ventilator was 13. One child died of sepsis irrespective of the mechanical ventilator. Six patients had health insurance. But 9 did not. The group with insurance had the possibility of being discharged earlier than the group without. On readmission, the length of hospitalization was also reduced in patients who had used a home mechanical ventilator. CONCLUSION: Use of a mechanical ventilator at home is helpful in patients who need long-term use of a mechanical ventilator due to neuromuscular disease, chronic pulmonary diseases, and accidents because complications are rare and insurance coverage is feasible.

Comparison between Conventional Cystometry and Diuretics Stimulated Filling Cystometry in Neurogenic Bladder after Spinal Cord Injury

OBJECTIVE: To determine whether cystometry performed by bladder filling stimulation using furosemide (DCMG) reveals different findings compared to conventional cystometry (CCMG) in the neurogenic bladder. METHOD: The maximum intravesical pressure (MPves) and compliance of the bladder in CCMG and DCMG were compared in 24 patients with neurogenic bladder after spinal cord injury. The MPves was estimated by urethral leak pressure or intravesical pressure at 600 ml filling. Compliance was calculated from the cystometric bladder capacity and the MPves. For CCMG, the bladder was filled with 32oC normal saline via 10 F urethral catheter at 50 ml/min until the patient leaked or filled 600 ml. Three hours later, 20 mg of furosemide was injected intravenously after intravenous infusion of 300 ml normal saline for DCMG. Ultrasound measuring of filled urine volume was made at least every 5 minutes until defined MPves. RESULTS: Significant differences were found between DCMG and CCMG in hyperreflexic neurogenic bladders with respect to: decrease in MPves (p0.05). CONCLUSION: We have found DCMG provides a more effective and near physiological diagnostic method of detrusor characteristics than CCMG in evaluating both genuine MPves and compliance in patients with hyperreflexic neurogenic bladder.