Abstract:
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The concept of community critical care within the UK is fairly new. Pockets of this type of care and management exist across the country but it is often carried out on an informal or limited basis even though there are over 3000 patients who are registered as receiving home mechanical ventilation (excluding continuous positive airway pressure) invasively and non invasively.1 These patients are a heterogeneous group and include those with neuromuscular disease, rib cage deformity, spinal injury, COPD and obesity. Their numbers have increased exponentially over the past few years and this trend is set to continue form any reasons such as technical advances, increased understanding of such disease processes and survival from prolonged critical illness. These patients, there fore, will require input at home or in an intermediate care facility from a critical care team to support and manage symptoms, give psychological support, change ventilatory requirements during exacerbations, facilitate a weaning programme when appropriate and support palliative care issues. Sending patients home from acute care who require invasive ventilation is fraught with obstacles, anxiety, lack of understanding and prejudice from all areas of the healthcare system with the largest driving force being how cost effective is home mechanical ventilation (HMV)? However, this nilhistic approach to HMV is no longer acceptable and a change in attitude from health care professionals and society as a whole needs to be realised. Developing community critical care as a model of care for the 21st century in order to meet the needs of this patient group is paramount and requires a partnership between primary and secondary care trusts, the independent sector and industry. At all times it must aim to maintain quality in terms of process, patient quality of life and life satisfaction and equality across disability. Reference : 1 Lloyd-Owen et al (2005) Patterns of home mechanical ventilation use in Europe. Eur Respir J 25 : 1025-1031
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