Performance of mechanical ventilators at the patient's home: a multicentric quality control study

Ramon Farré ^1*, Daniel Navajas ¹, Enric Prats ², Sergi Marti ³, Rosa Guell ⁴, Josep M Montserrat ⁵, Cristian Tebe ⁶ and Joan Escarrabill ⁷

¹ Universitat de Barcelona-IDIBAPS, Spain
² Hospital Universitari Bellevitge, Spain
³ Hospital Universitari Vall d'Hebron, Spain
⁴ Hospital Universitari Sant Pau, Spain
⁵ Hospital Clinic-IDIBAPS, Spain
⁶ Agencia d'Avaluacio de Tecnologia i Recerca Mediques de Catalunya, Spain
⁷ Hospital Universitari Bellvitge, Spain

^* To whom correspondence should be addressed. E-mail: rfarre{at}ub.edu.

Accepted 29 January 2006

Abstract

Background: A multicenter quality control survey of home mechanical ventilation (HMV) based on testing the ventilator at the patient's home was carried out.

Methods: The study, which was performed at the home of 300 patients included in the HMV programs of 4 hospitals in Barcelona, consisted of three steps. First, we compared the prescribed ventilation settings, the actual settings in the ventilator control panel and the actual performance of the ventilator measured at home. Second, the different ventilator alarms were tested. Finally, we ascertained whether disagreement between the prescribed settings and the actual performance of the ventilator had an impact on non-programmed readmissions of the patient.

Results: Considerable differences (mean and limit of agreement) were found between actual, set and prescribed values of ventilator variables, these differences being similar in volume- and pressure-preset ventilators. The percentage of patients with a discrepancy between the prescribed and actually measured main ventilator variable (minute ventilation or inspiratory pressure) greater than 20% and 30% was 13% and 4%, respectively. The number of ventilators with built-in alarms for power-off, disconnection or obstruction was 225, 280 and 157, respectively. These alarms did not work in 2 (0.9%), 52 (18.6%) and 8 (5.1%) ventilators, respectively. The number of non-programmed hospital readmissions in the year prior to the study did not correlate with the index of ventilator error.

Conclusions: This study illustrates the current limitations of the quality control of HMV and suggests that improvements should be made to ensure adequate ventilator settings, correct ventilator performance and ventilator alarm operation.

Keywords: chronic respiratory failure, home mechanical ventilation, quality control, ventilator alarms, ventilator performance

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