Résumé :
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Introduction Advances in life prolonging and life saving interventions over the past 30 years have lead to a rapidly growing subgroup of patients who are unable to be weaned from mechanical ventilation in the long term. These patients, therefore, will either require invasive mechanical ventilation for the rest of their life or a protracted weaning plan outside the acute care facility. The plight of these patients is often difficult as there are limited resources within the community, no national guidelines to direct the process of care and management of this group of patients and a lack of appropriate intermediate care facilities to discharge the patient to outside the acute care setting. Background The Lane Fox Respiratory Unit (LFRU) is a national weaning centre for Greater London and the South East of England. It is very experienced in discharging the complex ventilator dependent patient back into the community. It is through this experience that a pathway of care has been developed to help guide all healthcare professionals in an adult critical care setting to successfully discharge the complex ventilator dependent patient. The Pathway The pathway should be used as a guide/framework in the process of discharge. The key to its success is nominating a dedicated coordinator throughout the discharge process. The pathway has 4 phases (see Figure 1). This is not a prescriptive framework and will require adaptation based on the needs of the individual patient and family, the availability of resources and local practice. Summary With careful planning and use of the pathway, discharge to the community can succeed but the healthcare team need to be aware of the common difficulties that often thwart the process and include : • Delays in funding • Unsuitable housing • Lack of appropriate intermediate care • Failure to recruit appropriately trained carers or qualified nurses
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