Srinivasan S, Doty S M, White T R, Segura V H, Jansen M T, Davidson Ward S L, Keens T G
Division of Pediatric Pulmonology, Childrens Hospital Los Angeles, University of Southern California School of Medicine, 90027, USA.
Chest. 1998 Nov;114(5):1363-7. doi: 10.1378/chest.114.5.1363.
The safety of home ventilators has been questioned. We collected data to study the following: frequency of home ventilator failure, apparent causes for the failure or malfunction, and adverse consequences following the failure.
Information on all requests to correct home ventilator failures reported to a home respiratory equipment vendor was collected prospectively between November 1991, and November 1992.
There were 150 ventilator-assisted patients aged 2 to 77 years; 44 were < or = 18 years. They received 841,234 h of home mechanical ventilation (average, 15.4 h/d per ventilator-assisted patient).
There were 189 reports of home ventilator failure. Defective equipment or mechanical failure was found in only 39% (73 reports), equivalent to one home ventilator failure for every 1.25 years of continuous use. Other causes of ventilator failure included the following: improper care, damage, or tampering with the ventilator by caregivers (13%), functional equipment improperly used by caregivers (30%), and equipment functional but the patient's condition changed, mimicking ventilator failure (3%). No problem could be identified in 16%. The following actions were required: ventilator replacement (44%), repair of a defective part (6%), replacement of a functioning ventilator for psychological comfort (14%), ventilator adjustments made (21%), caregiver reeducation (7%), caregiver anxiety or distress reduced (3%), and no action required (4%). Hospitalization was required only in two cases (1%). No adverse outcomes, deaths, or serious injuries were associated with home ventilator failure.
We conclude that in 150 patients requiring home mechanical ventilation, ventilator failure occurred relatively infrequently, and there were no adverse outcomes as a result of equipment failure at home. We speculate that equipment failure is not a frequent or serious problem for ventilator-assisted patients treated at home.
家用呼吸机的安全性受到质疑。我们收集数据以研究以下内容：家用呼吸机故障的频率、故障或失灵的明显原因以及故障后的不良后果。
前瞻性收集了1991年11月至1992年11月期间向一家家用呼吸设备供应商报告的所有纠正家用呼吸机故障的请求信息。
有150例使用呼吸机辅助的患者，年龄在2至77岁之间；44例年龄小于或等于18岁。他们接受了841,234小时的家庭机械通气（平均每位使用呼吸机辅助的患者每天15.4小时）。
有189份家用呼吸机故障报告。仅39%（73份报告）发现设备有缺陷或机械故障，相当于每连续使用1.25年发生一次家用呼吸机故障。呼吸机故障的其他原因包括：护理人员护理不当、损坏或擅自改动呼吸机（13%）、护理人员对正常运行的设备使用不当（30%）以及设备正常但患者病情变化，类似呼吸机故障（3%）。16%未发现问题。需要采取以下措施：更换呼吸机（44%）、修理有缺陷的部件（6%）、为心理安慰更换正常运行的呼吸机（14%）、进行呼吸机调整（21%）、对护理人员进行再教育（7%）、减轻护理人员的焦虑或困扰（3%）以及无需采取行动（4%）。仅两例（1%）需要住院治疗。家用呼吸机故障未导致任何不良后果、死亡或严重伤害。
我们得出结论，在150例需要家庭机械通气的患者中，呼吸机故障发生相对较少，且在家中未因设备故障导致不良后果。我们推测，对于在家接受呼吸机辅助治疗的患者，设备故障并非常见或严重问题。
