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Mechanical ventilation in a nursing home setting, a single centre's fifteen year experience.
Keywords: mechanical ventilation nursing home
Researchers: Prof. dr. S.U. Zuidema Prof. dr. P.J. Wijkstra dr. W. Drenthen drs. G. Huisman
Nature of the research: Retrospective cohort / file research
Fields of study: pulmonology rehabilitation intensive care

Background / introduction

In the Netherlands, long-term mechanical ventilation is mainly coordinated by the 4 centers for Home mechanical ventilation (HMV) (in dutch, Centrum voor thuisbeademing or CTB). Patient with mainly neuromuscular disease, spinal cord lesions, neurological trauma and severe primary pulmonary respiratory failure are also patients in need of sufficient care . When patients are not suitable for HMV, in most cases due to absence of ventilator free time or increased ADL dependence, we provide this care in an unique nursing home setting. This nursing home department is the only facility in the Netherlands outside the hospital that can provide this treatment. Complications are frequent and complex in this patient population. Mortality is high. In addition, we also provide long-term weaning care for intensive care patients and follow-up care for patients with novel diaphragm pacing support.

Research question / problem definition

Create a systematic overview of fifteen year experience in our department, by using our medical and nursing care files.
- Types of patients (diagnosis, ADL dependence, medical history prior to admittance, demographic)
- Types of ventilatory support (invasive / non-invasive, pressure / volume, support or controlled)
- Duration of ventilation
- Complications during therapy (mainly ventilator associated pneumonia, tracheostomy related problems, autonomic dysfunction and pressure sores)
- Mortality and factors associated with mortality.
- Weaning success rate and factors associated with successful weaning.
- Discharge frequency and number of hospitalisations

Workplan

Step 1 Introduction phase ( 2-3 weeks)
- The student gets an opportunity to visit our department and participate in several activities (nursing, medical, psychosomatic)
- Introduction in ventilatory support
- The student performs a review of literature regarding long-term ventilatory support
Step 2 Data retrieval (8-10 weeks)
- The student decides together with PI (dr W. Drenthen) a subject of interest.
- Additional literature regarding subject of interest is retrieved, for example weaning.
- The student gets access to our medical and nursing files, readily accessible.
- SPSS template for data retrieval is composed.
- Data retrieval itself
Step 3 Statistical analyses (4 weeks)
- Frequency statistics and univariate / multivariate analyses depending on subject of interest (supported by PI)
- Starting with writing introduction and methods section
Step 4 Scientific report (remaining weeks of 20 weeks)
- According to the standards required by the faculty
- Results and discussion.
Step 5 If possible, a scientific article for an international peer-reviewed journal will be written. The student will be a co-author, position of co-authorship will depend on the effort provided.

References
Frequency and management of respiratory incidents in invasive home ventilation. Stieglitz et al. Chron Respir Dis. 2013;10:135-40 Inpatient chronic assisted ventilatory care: a 15-year experience. Wijkstra PJ, Avendaño MA, Goldstein RS. Chest. 2003;124:850-6.

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