Patients who need home mechanical ventilation do not have to be admitted to the hospital for the initiation of it. The start can now be done effectively and safely at home, while the patients are subsequently monitored via telemonitoring. In addition this is more comfortable for patients and it saves costs up to € 3,000 per patient. These are the conclusions of a thesis written by nurse practitioner Anda Hazenberg from the Center of Home Mechanical Ventilation [Centrum voor Thuisbeademing] at the UMCG. She will get her PhD by the University of Groningen on March 8th 2017.
Patients who need home mechanical ventilation are dependent on a ventilator, usually for the rest of their life. The ventilator assists or takes over the patient's breathing. In the Netherlands this treatment has been offered since 1960. The number of people needing home mechanical ventilation has increased significantly over the past years, rising to almost 3,000 in 2016. It includes patients with a neuromuscular disease, thoracic cage problem, lung disease or sleep apnoea. The main aim of home mechanical ventilation is to improve a patient's quality of life while in most patients it improves survival.
Initiation of the ventilator
In her research, Anda Hazenberg examined whether there was a safe and effective way to adjust home mechanical ventilation remotely, i.e. outside hospital. In the Netherlands, home mechanical ventilation is usually initiated in hospital. The patient is admitted to a general ward for 8 days, and is even for 2 nights in an intensive care so night-time blood tests can be carried out.
Safe and effective at home
Hazenberg studied 77 patients as they started using home mechanical ventilation; half of them started at home and the other half in the hospital. Telemonitoring was used to check patients outside hospital; this involved both checking data from the ventilator as well as from the device needed to observe te gas exchange. The data for the two groups was compared six months after the start of home mechanical ventilation. Similar improvements in the carbon dioxide and oxygen levels in the blood and in the quality of life were seen in both groups, leading Hazenberg to conclude that the initiation of home mechanical ventilation at home is not only as safe, but also as effective as in hospital. This is big advantage for these severely impaired patients as they prefer to start at home as the support from partners and health care workers is already optimised at home. In addition, is saves € 3,000 per patient if the initiation of home mechanical ventilation starts at home
Other method of measuring
Hazenberg also examined the effect of another healthcare innovation. She tried to discover whether it would be possible to measure the carbon dioxide and oxygen levels outside the hospital through the skin rather than with a blood test, by attaching a sensor to the earlobe (transcutaneous). The results of her study were reliable, showing that the method can be used to monitor patients outside hospital.
According to Hazenberg, her thesis proves that clinical research combined with technical innovation can improve the care provided to patients in need of home mechanical ventilation while it is cheaper as well.
Anda Hazenberg (1962, Wieringermeer) studied nursing in Hoogeveen. She conducted her research at the Groningen Research Institute for Asthma and COPD (GRIAC) in the UMCG. Her thesis is entitled: ‘Innovation in home mechanical ventilation’. She currently works as a nurse practitioner at the center of Home Mechanical Ventilation in the UMCG.