Home treatment of infection-related acute respiratory failure in kyphoscoliotic patients on long-term mechanical ventilation

BACKGROUND: In patients with kyphoscoliosis, long-term mechanical ventilation improves chronic alveolar hypoventilation during spontaneous breathing, improves quality of life, decreases the need for hospitalization, and improves survival. In these patients respiratory infection can precipitate acute respiratory failure (ARF) that requires hospitalization. OBJECTIVE: To study the possibility of home treatment of infection-related ARF in kyphoscoliotic patients on long-term mechanical ventilation. METHODS: During a period of 4 years, 8 kyphoscoliotic patients (3 women, 5 men, mean +/- SD age 61 +/- 10 y, mean Cobb angle 84 +/- 7 degrees), who had been using overnight mechanical ventilation (delivered by either volume-limited [4] or pressure-limited [4] ventilators) for 31 32 months, developed infection-related ARF. Seven patients agreed to be treated at home, with an increase of the daily duration of mechanical ventilation to > 20 hours, and antibiotics. Blood oxygen saturation was monitored via pulse oximetry during mechanical ventilation and overnight, to determine whether to add or increase supplemental oxygen. A nurse, a general practitioner, and a chest specialist made scheduled visits to each patient. RESULTS: All 7 patients were successfully treated at home. In 2 patients supplemental oxygen flow was slightly increased. Two patients who had not previously been receiving supplemental oxygen received supplemental oxygen for a few days. The patients progressively decreased the daily duration of mechanical ventilation, according to their ability to breathe comfortably without mechanical assistance, under the supervision of the medical staff, and they all returned to their baseline (pre-ARF) condition in 4 weeks. CONCLUSION: In kyphoscoliotic patients on long-term mechanical ventilation, home treatment of infection-related ARF is possible and effective, provided there is adequate collaboration by the patients and their relatives, and staff well-trained in mechanical ventilation and other aspects of the home care of these patients.