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Long-term ventilation has been a successful part of the management of chronic respiratory failure since the use of the iron lungs was introduced during the polio epidemics in the 1930s and 1940s. The transition from hospital-based therapy to genuine home ventilation was pioneered by a number of physicians and patients including Robert Cavendish whose story was dramatised in the recent biopic ‘Breathe’. Robert Cavendish used his financial backing and engineering contacts to develop the first wheelchair mounted ventilator marking a watershed in the management of ventilator-dependent patients; empowering patients with chronic respiratory failure to live independent of a healthcare environment. Improvements in technology, for example, positive pressure ventilation, have facilitated the move from hospital to community support for complex respiratory patients; however, this comes at a cost to the patient, caregivers and the health system. The cost to the health system is rising as the number of patients’ requiring home mechanical ventilation (HMV) increases1 in line with growing data to demonstrate its effectiveness in chronic respiratory failure secondary to different …
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