Evaluation of factors influencing the reduction of home mechanical ventilation dependency in patients planned to receive home health care

BACKGROUND: With increasing life expectancy and the growing burden of chronic diseases, healthcare systems are shifting from hospital-centered models to community- and home-based care. The use of home mechanical ventilators (HMVs) facilitates early discharge from hospital settings yet creates significant physical, psychological, and social burdens for caregivers. Identifying strategies to reduce ventilator dependency during palliative inpatient care may alleviate these challenges. METHODS: This retrospective, cross-sectional, descriptive study employed a quantitative approach with purposive sampling. The study included 75 bedridden patients who were transferred from intensive care units (ICUs) to palliative care services with a planned transition to home healthcare. A multidisciplinary rehabilitation program encompassing respiratory, physical, nutritional, and psychological interventions was systematically implemented in the palliative care unit. Data on the patients' functional and nutritional status, as well as pressure ulcer risk scores, were collected and analyzed to evaluate their association with successful weaning from HMV. RESULTS: Among the study population, 77.3% (n = 58) were successfully weaned off HMV. Significant predictors of ventilator weaning included higher Early Functional Ability (EFA) scores at admission, particularly in the sensorimotor and cognitive domains, as well as greater improvement in Karnofsky Performance Scores during the palliative stay. Improvements in nutritional and pressure ulcer risk scores were not significantly associated with ventilator weaning. CONCLUSIONS: Multidisciplinary palliative care with targeted rehabilitation interventions may effectively reduce HMV dependency in patients transitioning from intensive care. A higher initial functional status and improvements in physical performance are key determinants of successful weaning, potentially lowering the burden on caregivers in home settings.