The Ventilator-assisted Individuals Study.

A paucity of reliable data exists concerning ventilator-assisted individuals (VAIs) for program planning. The Chicago Lung Association, with funding from Blue Cross/Blue Shield of Illinois, conducted a community action project to determine the magnitude of the issues in Illinois. The purposes of the VAI Study were to ascertain needs and resources, generate recommendations, and recruit community involvement. The survey identified 453 VAIs: 145 in hospitals, 105 in extended-care facilities, and 203 at home. A majority (62 percent) of hospitals provided services to VAIs; many more would with proper reimbursement incentives. Only 60 percent of hospitals serving VAIs had active discharge teams; discharge was accomplished by a variety of mechanisms and personnel. Monthly hospital charges averaged $22,190 with a range from $10,020 to $66,750 depending on the location of the patient. Most reimbursement was public; private funding was fragmented. Major discharge barriers were inadequate payment for community-based services, limited community resources, constrained consumer's finances, and lack of access to information. Recommendations for future community action included establishing a technology transfer system, home care case management, an integrated management system, a documentation center, and trials and demonstrations prior to program and policy development.

Effects of limping on normal exercise response.

Ten subjects performed two identical exercise tests on a motor-driven treadmill while walking normally or while limping. The two tests were separated by a rest period sufficient to permit return to a base-line state and the sugjects were randomly assigned to a normal-limp or limp-normal exercise sequence. Work rate was varied progressively by increasing treadmill grade in 5-degree increments to a maximum of 20 degrees, while limping was induced by insertion of a 0.5-cm wooden spike under the heel of the dominant foot. At all work rates, limping produced consistent increases in all variables studied, except for tidal volume where a decrease was seen. At the highest work rate these differences tended to disappear. Even considering the greater O2 consumption induced by limping, there were still significant (P less than 0.01) increases in both respiratory rate and ventilation at all but the highest work rate, accompanied by an insignificant fall in tidal volume. This suggests that these changes were not induced by the alterations in the internal or external work of walking and that limping somehow alters the regulation of exercise hyperpnea.