[Proceedings: Home care in chronic respiratory insufficiency. Indications for the prescription of a home respirator, its various types and possibilities for use].

Justified doubts exist in regard to the effectiveness of a long term home care plan for patients with stable chronic obstructive lung disease (COLD), especially when intermittent positive pressure breathing (IPPB) home care is advocated. Conclusive long term studies are lacking, however. In conjunction with all other possibilities offered by a well organized home care plan, IPPB still appears to be an appropriate therapeutic adjunct in the form of regular airway cleaning 3-6 times per day. This entails repeated inhalations of an aerosol with bronchodilator and surface active humidifier, frequently repeated mobilization of mucus and expectoration, deepening of tidal volume with increase of alveolar ventilation, and consequent amelioration of the arterial blood gases and pulmonary arteriolar resistance. Two simple home care respirators may be useful in carefully selected and cooperative patients with stable COLD and chronic respiratory failure: 1. the Fluidic-Assistor, which is automated, simple to use and sterilize, and inexpensive, but noisy and difficult to adjust for pressure and flow by the patient; 2. the Monaghan 515, which is automated, fully adjustable for pressure and flow by the patient, quiet and of pleasing design but difficult to handle and expensive. A preliminary study of the Minibird 2 with apneustic flow time regulation has been performed with five stable COLD patients. A positive end-inspiratory pressure of 20 cm H2O, an inspiratory time of 3+/-0.5 sec and an apneustic flow time of 1.5+/-0.5 sec were used. An 20 mm Hg fall in blood pressure and additional arterial hypoxemia seemed to be due to a decrease in cardiac output. Also, apneustic flow time did not significantly increase the FEV1 and is therefore not recommended for home care.