• Louise Rose, Douglas A McKim, Sherri L Katz, David Leasa, Mika Nonoyama, Cheryl Pedersen, Roger S Goldstein, Jeremy D Road, and CANuVENT Group.
• Department of Critical Care and Research Institute, Sunnybrook Health Sciences Centre; the Lawrence S Bloomberg Faculty of Nursing, University of Toronto; the Provincial Centre of Weaning Excellence/Prolonged Ventilation Weaning Centre, Toronto East General Hospital; Mt Sinai Hospital; Li Ka Shing Knowledge Institute, St Michael's Hospital; and West Park Healthcare Centre, Toronto, Ontario, Canada. louise.rose@utoronto.ca.
• Respir Care. 2015 May 1; 60 (5): 695-704.

BackgroundNo comprehensive Canadian national data describe the prevalence of and service provision for ventilator-assisted individuals living at home, data critical to health-care system planning for appropriate resourcing. Our objective was to generate national data profiling service providers, users, types of services, criteria for initiation and monitoring, ventilator servicing arrangements, education, and barriers to home transition.MethodsEligible providers delivering services to ventilator-assisted individuals (adult and pediatric) living at home were identified by our national provider inventory and referrals from other providers. The survey was administered via a web link from August 2012 to April 2013.ResultsThe survey response rate was 152/171 (89%). We identified 4,334 ventilator-assisted individuals: an estimated prevalence of 12.9/100,000 population, with 73% receiving noninvasive ventilation (NIV) and 18% receiving intermittent mandatory ventilation (9% not reported). Services were delivered by 39 institutional providers and 113 community providers. We identified variation in initiation criteria for NIV, with polysomnography demonstrating nocturnal hypoventilation (57%), daytime hypercapnia (38%), and nocturnal hypercapnia (32%) as the most common criteria. Various models of ventilator servicing were reported. Most providers (64%) stated that caregiver competency was a prerequisite for home discharge; however, repeated competency assessment and retraining were offered by only 45%. Important barriers to home transition were: insufficient funding for paid caregivers, equipment, and supplies; a shortage of paid caregivers; and negotiating public funding arrangements.ConclusionsVentilatory support in the community appears well-established, with most individuals managed with NIV. Although caregiver competency is a prerequisite to discharge, ongoing assessment and retraining were infrequent. Funding and caregiver availability were important barriers to home transition.Copyright © 2015 by Daedalus Enterprises.

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