P-2-16-02
INTENSIVE HOME CARE FOR THE PEDIATRIC VENTILATOR ASSISTED PATIENT (PVAP)
T. Hilton, R. Perkin, D. van Stralen, K Craig, LLU Medical Center, Loma Linda, CA. USA
Home care for the PVAP is a desirable option when qualified support systems are in place. Current and future directions in medical care and third party payers support home mechanical ventilation (HMV). LLU Medical Center has managed 43 PVAP in HMV since 1982 and currently has 30 active patients. In 1995 LLUMC HMV team developed an interdisciplinary specialty team clinic including a physician, nurse specialist, respiratory therapist, nutritionist, social worker and child life therapist. Each team member assesses the child management problems and reviews/develops a plan of care to be followed both on a short term and long term basis. Management issues include; mechanical ventilation, airway care, medications/treatments, nutritional support, psychosocial issues, developmental issues and reintegration into community and school system The PVAP now has access to a comprehensive interdisciplinary management approach which encourage early intervention for medical and psychosocial issues. We believe this results reduced potential for readmission to acute care, improved quality of life, enhances of home program compliance and continuity of care.
P-2-16-03
EARLY INTERVENTIONS USING VENTILATORY SUPPORT FOR THE DUCHENNES MUSCULAR DYSTROPHY (DMD) PATIENT
T. Hilton, P. Gold, R. Perkin, Loma Linda University Medical Center, Loma Linda, CA., USA
With the advent of technology and availability for home mechanical ventilation (HMV) and rehabilitation, more patients, when offered, choose HMV and extended life. Patients frequently remain in the Intensive Care Unit (ICU) for 3-4 months with multiple unsuccessful weaning attempts. We are currently changing our management of this patient population and other terminal diagnoses utilizing a staged approach. Elective admissions may be planned to assure successful use of non-invasive or invasive ventilation. We have developed and algorithm for management of these patient, starting in a clinic setting, through hospitalization and home care/subacute care. Education programs have been initiated in support groups to discuss advance directives. Patients verbalize comfort in being able to participate in their end of life care decisions. Trauma to the patient has been minimized, quality of life has been improved, life is extended and care has been far more cost effective. Three month stays in the ICU have been reduced to 4 days for early interventions of non-invasive ventilation.
