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SUMMARYLong term ventilatory assistance can offer the patient a new lease on life for many years.In Portugal the absence of home care organizations able to provide medical and logistical support to patients undergoing long term ventilatory assistance, leads to the incapacity to discharge them from the intensive care units with the consequent raise in the ratio cost/benefit of this treatment.Success in long term ventilatory assistance is based on some essential factors:•It should be based upon appropriate selection criteria and guidelines.•It is important to create suitable home care organizations and rehabilitation and long term ventilation units able to give the patients and their families the adequate preparation and training before discharge or even able to provide a home for those with severe social and echonomical handicaps.In this work we show our experience with patients undergoing home mechanical ventilation and we present a proposal of organization of a home mechanical ventilation program.

SUMMARYLegionella pneumophila (LP) is a common bacteria of the environment, and it is an agent responsible for severe community acquired pneumonia (CAP). We analyzed the, 12 patients with Lp pneumonia admitted in our Respiratory ICU during the last 10 years (1986-1996). They represented 6,7% of CAP. Eleven patients were males and 1 female, with mean age 49,6±11,9years. TISS was 25,8±9,5 and APACRE II 23,4±6,5. All, but 1 patient, were under mechanical ventilation (MV) during a mean period of 11,5±12,5 (min: 1, max:44) days.Four pneumonias occurred beyond the season, while only 4 patients had an epidemiological history. Only 1 patient had no risk factor. In all the others tobacco smoking and alcohol abuse were quite frequent. Diagnosis was based on serologic test and culture or direct fluorescent antibody staining of bronchial secretions.Eleven patients had a multisystemic disease with hepatic dysfunction in 9, renal failure in 7 (due to rhabdomyolysis in 4). One patient had a endocarditis and another developped ARDS. Nosocomial septicaemie occurred in 5 patients.Mortality rate was 58,3%. Deceased patients bad initially higher APACHE n, (A-a) 02, and lower natremia. Comparing Lp pneumonia with the other CAP (n=166), both submitted to MV, the higher mortality rate was not significant statisticly (58,3% versus 31,8%). In conclusion Lp pneumonia can occur all over the year. There was a high incidence of severe complications and outcome was similar to the other CAP when requiring MV.REV PORT PNEUMOL 1998; IV (2): 139-145