[National respiration center support patients with tracheostomy tubes. Outpatient clinic for respiratory support in the home].

It is now 60 years since the polio epidemic in Copenhagen and the first use of prolonged invasive positive pressure ventilation. After this pioneer work positive pressure ventilation rapidly became well established. Intubation/tracheostomy and mechanical ventilation are now standard in Intensive Care Units. In the late 1970 Gillis Andersson was the first in Sweden to discharge patients home with invasive mechanical ventilator support. His pioneer work included the development of a dedicated practical and technical support organization at National Respiration Centre at Danderyds Hospital. This unit developed skills in patient customized tracheostomy tube construction and home invasive ventilation supportive care. Tracheostomy tubes and home ventilators have since then developed rapidly. Some patients still need customized tracheostomy tubes, which the NRC supplies. The production is certified by the Swedish Medicinal Product Agency. Today invasive home ventilation is standard care. Invasive mechanical home ventilation when instituted as a life-saving therapy in, for example, progressive ALS patients is complex and resource-intensive. New aspects such as training and education in order to secure quality of care in the home environment is one of many challenges. When commencing invasive ventilation in patients with progressive neurological disease ethical considerations must also be acknowledged, e.g. aspects such as patients' perhaps changing wishes during the course of illness regarding cessation of life support.