Authors (including presenting author) :
Ruth Lau KY (1), Yeung YC (1), Lam WC (1), Grace Chan (1), Ng YT (1), Chu YM (1), Suen YY (1)
Affiliation :
(1) Respiratory Team, Department of Medicine and Geriatrics, Princess Margaret Hospital
Keyword 1: :
Home Invasive Mechanical Ventilator
Keyword 2: :
Caregiver training
Keyword 3: :
multidisciplinary team MDT
Introduction :
The number of patients requiring long-term invasive mechanical ventilation has increased in recent years due to improved care provided in critical care settings. [1] For patients with neuromuscular disorders and respiratory failure who become dependent on invasive mechanical ventilation through tracheostomy, prolonged hospitalization can last months or even years. The Home Invasive Mechanical Ventilator (HIMV) Training Program has been implemented at Princess Margaret Hospital (PMH) to address this need. The program adopts a multidisciplinary team (MDT) approach, which includes respiratory physicians, specialty nurses, and allied health professionals. Patients will be recruited for the program if they meet two essential criteria for home ventilator care: medical stability, and the availability of adequate caregivers to provide HIMV care for the patient. Within this framework, respiratory nurses play a pivotal role in coordinating training, facilitating MDT collaboration, and communicating with patients and caregivers. Furthermore, they provide tailored ventilator training to ensure a smooth and safe transition for patients from hospital to home.
Objectives :
1.Equip caregivers with the knowledge and skills necessary to independently manage the ventilator, fostering confidence in handling daily care and emergency situations.
2.Facilitate understanding of ventilator settings, operation, and troubleshooting techniques to ensure safe and effective use of the equipment, minimizing complications and risks.
3.Provide continuous support to ensure patients experience a smooth and safe transition from hospital to home.
Methodology :
1.Conduct comprehensive assessments to identify the needs of patients and caregivers, and develop a tailored training program.
2.Provide clear and concise educational materials, such as training booklets and cue cards (Figure 1), covering essential topics including ventilator operation, troubleshooting, equipment care, and emergency handling (Figure 2).
3.Collaborate with the MDT to deliver a holistic training approach encompassing all aspects of ventilator care.
4.Formally evaluate caregivers' baseline knowledge and skill proficiency using checklists (Figure 3).
5.Offer ongoing support for families to address concerns and advocate for the patient's specific needs and preferences.
Result & Outcome :
Internationally, the average survival within HIMV programs varies from 1.9 to 12.3 years.[2] Our results align with this finding (Appendix 1). From 2017 to 2025, we successfully completed HIMV training for a total of six cases, comprising four males and two females, with ages ranging from 28 to 75 years. Prior to training, their hospital stays ranged from 5 to 64 months. Unfortunately, two patients have since passed away, with survival durations ranging from 14 to 17 months. As of December 31, 2025, the surviving patients have survival durations ranging from 2 to 101 months, with an average rate of unplanned emergency admissions of 0.7 per year. Long-term invasive mechanical ventilation at home provides a more comfortable and cost-effective solution for patients with chronic respiratory failure who have recovered from an acute event in a healthcare facility. [3] The primary challenges associated with HIMV care are the caregiving burden and lack of confidence among caregivers. To address these challenges, we are committed to developing a robust training program and providing holistic care and support for patients and caregivers through MDT. Additionally, we actively explore community resources to facilitate greater acceptance of HIMV care among caregivers. Ultimately, our goal is to empower more long-term ventilator-dependent patients to return
