Authors (including presenting author) :
Choi MW(1), Fung MS(1), Chan HL(1), Chan YY(1), Cheung MT(1), Cheung YF(1), Chiu LT(2), Fung WY(1), Karn KY(2), Lam CK(1), Ma SC(1), Mok WS(4), Ng LM(3), Poon CL(1) , Seto WM(1), Siu MT(1), So MS(5), Suen KM(1), Tang WT(1), Wong YF(1), Yeung KW(1), Yu CW(1), Chan SE(1), Cheng SL(1), Hung MM(1), Lee CL(1), Tsui SN(1), Wan MT(1), Ho SM(1), Tsang WY(1), Ng SW(1), Cheung PS(1)
Affiliation :
(1) Respiratory Division, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong Hospital Authority (2) Community Nursing Service, United Christian Hospital, Hong Kong Hospital Authority (3) Department of Medical Social Service, United Christian Hospital, Hong Kong Hospital Authority (4) Department of Occupational Therapy, United Christian Hospital, Hong Kong Hospital Authority (5) Department of Physiotherapy, United Christian Hospital, Hong Kong Hospital Authority
Introduction :
Over the past two decades, the proportion of HIMV has steadily increased worldwide. HIMV could improve survival and quality of life for selected patients e.g. Neuromuscular Diseases (NMD), upper airway tumor, high cervical injury, and respiratory failure. Ventilator Dependent Patients (VDP) may require mechanically assisted breathing to augment or replace spontaneous ventilation to achieve medical stabilization or sustain life. Patient eligible for HIMV requires a tracheostomy tube to provide ventilator support. This review described our Multi-Disciplinary Team (MDT) experience of caring for patients with HIMV from hospital to community. The objective of this paper was to review the management of these patients on HIMV in United Christian Hospital in the past years.
Objectives :
1. To describe the characteristics of VDPs 2. To review the mechanism to ensure that HIMV patients have access to safe, personalized and continuous care from hospital to community.
Methodology :
The cases of VDPs under the care of the ventilator program at the Respiratory Division in Department of Medicine & Geriatrics of United Christian Hospital between 2001 and January of 2025. The key components of the program include: - The MDT consists of Respiratory Specialists, Allied Health Professionals and Specialty Nurses - MDT holistic assessment, planning, implementation and evaluation - Initial acclimatization and prescription of ventilator - Equipment & Devices for home ventilation - Carers education and training - Home visit before discharge - Discharge planning - Continuity of care include regular medical follow-up, hotline support and respite care - Emergency management
Result & Outcome :
There were fourteen adult cases with 85.7% (n=14) of males and age ranged from 22 to 85 since 2001. All cases required invasive mechanical ventilation via tracheostomy. Indications for HIMV included neuromuscular diseases (64.4%); chronic lung diseases (21.4%) and airway problems (14.2%). Twelve cases of them were used model of tracheotomy tube Low Pressure Cuffed (85.7%). Regarding nutrients and feeding of 14 VDP cases, there were 42.9% of them required Percutaneous Endoscopic Gastrostomy (n=6), 35.7% of them required nasogastric tube feeding (n=5) and the 21.4% of them via oral feeding (n=3). All of the recruited VDPs had been successfully discharged from hospital to community. Unplanned admission ranged from 0.33 to 12.5 times per year. For the person-time, it ranged from 0.16 to 21.6 year. Conclusion: The HIMV management program could provide the VDPs quality and continuous holistic care from hospital to community. More clinical outcomes examining the effectiveness of the program would be explored for continuous improvement.
