Home Ventilation refers to the provision of mechanical ventilation (breathing assistance with a machine) via invasive (tracheostomy) and non-invasive (via natural airways) routes to a person with breathing insufficiency. It is a life-sustaining, organ-supporting treatment (analogous to dialysis), but the overarching aim is to maintain or even improve the quality of life of patients, by allowing them to live at home and pursue a lifestyle and activities with as much autonomy and dignity as possible.
Provision of Complex Home Ventilation requires multidisciplinary collaboration. The team is usually led by Specialist Physicians (Pulmonologists or Intensive Care Specialists), in collaboration with other physicians (Rehab, Palliative, Family physicians). Highly trained nurses (usually with a background of acute and community nursing) form the backbone of the teams, providing direct clinical care, care coordination and clinical education. A variety of therapists and medical social workers provide specialised support in their respective professional domains.
HVRSS currently is the de facto national home ventilation care programme for adult ventilator assisted individuals (VAIs) in Singapore and receives referrals from Public healthcare Institutions and community partners alike. The team sees a wide range of diagnoses in central spinal, neuromuscular, skeletal, cardiovascular and respiratory disorders. About two thirds of the patients suffered from degenerative neuromuscular diseases such as Amyotrophic Lateral Sclerosis (ALS), Duchenne muscular dystrophy and central pathologies such as spinal cord injury (SCI). There is also a small but growing group of patients from complex post-ICU discharges who require ventilatory support.
In Singapore, such teams have been set up in KKCH (since 2001), TTSH (since 2009) and NUH Paediatrics (since 2014). All three teams provide inpatient discharge planning, patient and family education, direct home care, further coordination of care needs of these especially vulnerable patients (if other specialist care in hospital is required, e.g. elective surgery or endoscopies), and support to other community providers (e.g. chronic sick units, nursing homes and inpatient hospices) if for some reason the patients cannot stay in their own homes, with their own families.
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