I'd like to acknowledge, commend, and widely recommend the article "Home Mechanical Ventilation" (May). Its author, Sandra L. Stuban, presents practical, truthful, and useful insights that are critically needed by all health care professionals who care for people requiring long-term home mechanical ventilation. Her discussion of basic fundamentals is a must-read for hospital-based professionals responsible for discharge planning as well has home-based personnel who provide support for ventilator-assisted individuals and their families. The article's unique perspective could only come from a highly experienced health professional who is also a ventilator user.
As a critical care pediatrician in the 1970s, I was given the challenge of developing home care for ventilator-dependent children. In the 1980s, I sought understanding from those who had first-hand experience during the era of poliomyelitis. I learned from "the experts," including the late Gini Laurie, founder of what are today called Post-Polio Health International and the International Ventilator Users Network (see http://www.post-polio.org and http://www.ventusers.org). I collaborated with former Surgeon General C. Everett Koop, disseminating "state of the art" information to encourage changes in professional practice and public policies. My earliest publications represented efforts to communicate information that I'd learned from health professionals who were experts in the field and, more importantly, from patients and their families. Later on, I collaborated with others on consensus statements that provided guidelines for management to a broader audience.
There is a critical need for health professionals who have been educated in the basic fundamentals of home mechanical ventilation. Nurses (especially those on critical care units) can play a special role in selecting and preparing good candidates. We need to revisit the guidelines and develop evidence-based best practices, taking into consideration the invaluable insights of ventilator users. This unique article provides good ideas about how we can best do this.
Allen I. Goldberg MD, Master FCCP
Past President, American College of Chest Physicians, Past President, American Academy of Home Care Physicians, Chicago