Associate Professor Mark Howard has been the director of the Victorian Respiratory Support Service and the Victorian Weaning Unit at the Austin Hospital for fifteen years, which provides state-wide services for domiciliary ventilation in Victoria and is Deputy Director Department of Respiratory and Sleep Medicine at Austin Health. He is a fellow of the Royal Australasian College of Physicians, board member for the Institute for Breathing and Sleep, Theme Leader in the Co-operative Research Centre for Alertness, Safety and Productivity, Adjunct Associate Professor at Monash University and Clinical Associate Professor at The University of Melbourne. He has overseen development of an ambulatory model for implementing ventilation, community housing for ventilator dependent patients, development of a diaphragm pacing service and state wide telehealth services for home ventilation patients, with current research interests include assessing optimal methods for implementing ventilation, evaluation of lung volume recruitment and reducing the impact of shift work in the healthcare sector.
Ventilation From The Hospital To The Home
The advent of non-invasive ventilation (NIV) has revolutionized how acute and chronic ventilatory failure is managed. Patients with acute ventilatory failure secondary to COPD and obesity hypoventilation are frequently managed with NIV in ward based high dependency units with superior outcomes compared to invasive ventilation. Long term home based NIV improves survival and quality of life in many neuromuscular conditions that result in ventilator failure due to respiratory muscle weakness, such as motor neuron disease and muscular dystrophy. Recent Australian and international trials suggest that simpler nocturnal nasal CPAP is as effective as NIV for most patients with obesity hypoventilation syndrome, and that there is a role for long term NIV in selected COPD patients with persistent ventilatory failure in order to reduce the risk of readmission to hospital. This lecture will enable clinicians to evaluate and identify candidates for acute ward based and long term NIV, and consider models for delivering this therapy in the hospital and home.