A headline from The Times newspaper of 14 August 2000¹—“Power cut kills man on home ventilator”—is likely to strike a chill in the heart of anyone involved in providing home respiratory care. Bearing in mind it is impossible to guarantee complete safety even in the hospital environment, what is the respiratory practitioner’s responsibility towards the individual receiving ventilatory support in the home, and how can these risks be minimised?

EXTENT OF THE PROBLEM

The recent Eurovent study² showed that there are around 21 500 individuals receiving home ventilation in Europe: about one third have neuromuscular conditions, one third parenchymal lung disease (mainly COPD), and the remainder have chest wall disorders (scoliosis, thoracoplasty, obesity hypoventilation syndrome); 13% use tracheostomy ventilation and around 10% are in the paediatric age range. Although the prevalence of home ventilation varies considerably, in nearly all regions there is a rapid growth in those receiving home non-invasive ventilation (NIV).

One of the difficulties in assessing the extent of ventilator related complications in the home/community is that in most countries there is no centralised database, and even where equipment failure is recorded the consequences of the malfunction for the patient are not clear. Further information on quality control of ventilator care in the home from the Eurovent survey has shown that only 56% of hospitals initiating home ventilation assessed whether patients or caregivers cleaned and operated the ventilatory equipment correctly after discharge from hospital, and even fewer centres (25%) were aware of a vigilance system for reporting adverse events or mechanical failure. Ventilator servicing was carried out by external equipment companies in many countries, but in general there was wide variation in provision.^2,3 In some countries such as France and Denmark …