Home mechanical ventilator device transitions: A narrative review of clinical considerations to create a transition tool

Objective Home mechanical ventilation (HMV) provides chronic respiratory support through invasive or non-invasive ventilation. Ventilator assisted individuals (VAI) represent a complex population with highly specialized care needs and increased healthcare utilization. The global Phillips Respironics recall resulted in the need to transition many VAI in Ontario to the alternative ResMed Astral 150 ventilator device. HMV device transitions are complex and require careful planning. The purpose of this narrative review is to assess clinical considerations for ventilator transition in patients receiving HMV in exisiting literature over the past 20 years to support the build of a ventilator key consideration checklist tool. Methods A narrative review of literature from two online databases (Ovid MEDLINE(R) ALL and EBSCOhost CINAHL Plus) was conducted to identify relevant articles. The review was completed in a systematic approach via Covidence. Results Evidence and key considerations were grouped into four themes: Patient Ventilator Synchrony, Equipment Selection, Interface and Circuit Considerations, Bench Testing and Ventilator Performance, and Standardization and Interdisciplinary Approach. Successful transitions require a standardized, interdisciplinary approach with appropriate readiness assessments, clearly defined failure criteria, a patient-centered approach, and strong knowledge of ventilator performance and available adjunctive supports. There is limited existing literature in providing guidance for safety switching ventilators for HMV patients. Further research is needed to guide data-driven development and implementation of standardized protocols as well as assessment of long-term patient and family outcomes. Conclusion Switching home mechanical ventilator devices for VAI is a complex process and requires careful planning with interdisciplinary collaboration, patient-centred focus, and evidence-based guidelines.