From mechanical ventilation to home-care: the psychological approach.

The mechanically ventilated individual has to cope with being in a situation of total dependence on a bodily external object for life-support. This condition may give rise to unprecedented psychological complaints, often concerning the patient's fear of death, feeling of abandonment, mutilation, and perceived changes of self-image. It is not only the patients but also their family members who will need help dealing with stressful situations, false beliefs, anxiety, and all the other emotions linked to mechanical ventilation. After discharge from the hospital, the immediate need to master and manage the home ventilator equipment may overshadow the psychological needs of the patients. Therefore, psychological support should be offered well before discharge, and periodically during ambulatory sessions. Another important factor associated with adaptation to mechanical ventilation and the following period at home, appears to be the level of communication within the family, and the degree of commitment between all family members. Helping patients and their family members to cope with technical and psychological aspects of mechanical ventilation will make the transition from the hospital environment to the home easier for both. From an ethical point of view, it is suggested that patients be informed that ventilation will not change the course of their underlying disease or prognosis.