[Intermittent mechanical ventilation as home care]. / Die intermittierende mechanische Ventilation als Heimbehandlung.

Nocturnal mechanical ventilation (NMV) is a promising technique increasing survival and improving the quality of life of myopathic and kyphoscoliotic patients. The indications for NMV must be careful and the patients strictly selected. NMV is rarely useful in patients with pulmonary diseases, like COPD or restrictive disorders. When a professional medical and paramedical support is locally available, NMV can be undertaken at home. Negative and positive pressure ventilation can be used for NMV. Actually, tracheostomy can be replaced very often by a new type of positive pressure ventilation via a nasal face mask. We present here our series of 11 patients submitted to NMV and describe carefully the problems and the results of a 5-years experience with NMV in Geneva.

Insufficient oxygen concentration obtained at domiciliary controls of eighteen concentrators.

The oxygen concentration (O2%) produced by 12 type A concentrators, with a working time of 28-18,099 h, and 6 type B concentrators, with a working time of 0-3,033 h, was measured over a 12 month period in the user's home, at a flow rate of 2 l.min-1. One hundred and two measurements of O2% (mean 82.9), made at least once monthly by a visiting nurse, showed that type A concentrators were usually delivering less than 92% expected O2. Four concentrators were delivering less than 40% O2 after a working time of only 4,000 h. Sixty two measurements made by the manufacturer confirmed these findings (mean 86.8). The 18 measurements performed by the nurse on the type B concentrators showed expected O2% values (mean 93.1). Our study demonstrates the necessity of regular clinical and technical surveillance, at the user's home, during long-term domiciliary oxygen therapy and the need for the manufacturer to incorporate an alarm system monitoring the O2% into oxygen concentrators.