The indications for articial ventilation in chronic respiratory insufficiency are generally those, in which alveolar hypoventilation occurs. This can be observed in some myopathic diseases (Duchenne disease, myotonies, glycogenoses), nervous system diseases (spinal muscular atrophy, myasthenia, Guillain-Barre syndrome, atrophic lateral sclerosis, anterior medullary inflammation) and postural deformities involving the thorax. Many cases of long-term artificial ventilation in hospital settings have been described [1,2,3,4]. The longest lasted for 21 years [5] in a patient who suffered from respiratory failure resulting from epidemics of anterior medullary horns inflammation in Copenhagen in 1953. In selected patients, requiring periodic ventilatory support with atmospheric air, the treatment at home is possible. 3 such cases are described.

1. A 17-year old male, suffering from Duchenne disease, was admitted to the hospital after cardiac arrest resulting from respiratory failure. After successful resuscitation he was transferred to the Intensive Therapy Unit and artificially ventilated (at the beginning - controlled, then - supported ventilation). A right-sided pneumothorax required introduction of the pleural suction drain for a period of 4 days. On the 6th day after admission tracheostomy was performed. The parents were instructed in the ventilator operation and tracheostomy tube care. The patient was discharged home with a ventilator Bennett MA1 (Puritan Bennett, USA). Since December 1997, the patient has not been hospitalised again.

2. A 30-year old female was admitted for the first time to the ITU in January 1992, with a diagnosis of kyphoscoliotic cor pulmonale. In 1984, in the postpartum period an episode of pulmonary thromboembolism took place, resulting in pulmonary hypertension, confirmed by heart catheterization. In 1991 she was treated pharmacologically in the Internal Medicine Department for circulatory insufficiency. Several months later she was admitted again with symptoms of decompensated respiratory and circulatory failure. The lose of consciousness, resulting from hypercapnia was the cause of her transfer to the ITU. Artificial ventilation was maintained for 3 days, than tracheostomy was performed. The patient returned several times to the ITU for short-term artificial ventilation. From February 1992 she spent 305 days in the ITU, ventilated artificially for 4-16 hours a day. Pharmacological treatment consisted of digitalis alkaloids, verapamil and diuretics. In January 1993 she was discharged home with a Companion ventilator (Puritan Bennett, USA). During the following four years the patient stayed at home. In May 1997 she was admitted again to the ITU for respiratory failure caused by bilateral pneumonia, which proved fatal.