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"ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212920300239?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619303047?idApp=UINPBA00003Z" "url" => "/03002896/0000005600000004/v3_202007180720/S0300289619303047/v3_202007180720/es/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Organization of Home Mechanical Ventilation in Europe: A Plea for Uniformity and Accreditation" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "206" "paginaFinal" => "207" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "João Carlos Winck" "autores" => array:1 [ 0 => array:3 [ "nombre" => "João Carlos" "apellidos" => "Winck" "email" => array:1 [ 0 => "jcwinck@mail.telepac.pt" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Faculty of Medicine, Porto University, Centro de Reabilitação do Norte, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Manejo de la ventilación mecánica domiciliaria en Europa: Tiempo de unificar y acreditar" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Home Mechanical Ventilation in Europe started as tracheostomy ventilation in the late 1970s<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a>; it remained under-utilized and restricted to specialized centres in France.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Due to the transition to non-invasive ventilator support, patients under Home Mechanical Ventilation (HMV) have grown worldwide.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Indeed, HMV became widespread in Europe and a survey (Eurovent) presenting data from 2001 to 2002 in 16 European countries (including a total of 483 centres), showed a global prevalence of 6.6 per 100,000 with a wide variation between countries.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In 2010, the European COPD audit (surveying 13 countries), showed that although a majority of centres offered invasive and noninvasive ventilation, 40.5% of centres declared not to have the capacity to ventilate at home all eligible patients.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In fact, organization varies widely in Europe, in countries like Denmark, where patients are referred to only 2 respiratory care units (RCU)<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a> or Sweden where there are a wide number of outpatient clinics that take care of the patients and report to the Swedish HMV Register (Swedevox), owned by the Swedish Society of Chest Medicine and financially supported by the National Board of Health and Welfare.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The Swedevox registry is a well-functioning national structure for implementing, monitoring, and securing valid prescription and management of both HMV and Longterm Oxygen Therapy.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In 2011, the British Thoracic Society Respiratory Critical Care Group, strongly suggested that National registries should be implemented to reduce variations in care and improve patient safety.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In a recent cross-national, cross-sectional study comparing one Australian and one Canadian predominantly publicly funded HMV services, there were marked regional differences in the clinical characteristics of individuals receiving assisted ventilation and the care practices used to support them. Yet, in spite of these differences Health Related Quality of Life was not different between the two sites. There were also considerable differences in the proportions of individuals using invasive ventilation, and undergoing PSG, home implementation of NIV, or using routine airway clearance techniques.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Based on assistance activities, technical and human resources, accredited training in ventilation, teaching and research activity the Spanish society of Pulmonology (SEPAR) has recently established the minimum requirements for a HMV centre, defining basic units (BU), Specialized Units (SU) and High Complexity Multidisciplinary Units (HCMU).<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">10,11</span></a> Currently there are in Spain, 13 HCMU, 12 SU and 9 BU.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In Portugal based on the same criteria we have characterized 18 HMV units (60% response rate) in 3 HCMU, 14 SU and 1 BU.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">According with German Guidelines for Chronic Respiratory Failure, 3 types of centres are defined: weaning centre, HMV centre with expertise in invasive HMV and HMV centre with special focus on NIV.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">14</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Additionally, the network “WeanNet”, founded in 2007 within the German Society of Pneumology and Respiratory Medicine (DGP), has undergone a certification process and by October 2018, 53 weaning centres have been certified.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">For complex patients (like invasively ventilated or under 24<span class="elsevierStyleHsp" style=""></span>h noninvasive ventilatory support) a home care package (including professional caregivers) is highly recommended. However, an adequate home care package (HCP) with professional caregivers is not available in the majority of European countries which unnecessarily delays hospital discharge and puts informal caregivers into a huge burden.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The table included shows a number of organizational aspects of some European countries together with the most recent available prevalence of HMV<span class="elsevierStyleSup">16-21</span>. Countries like the Netherlands and Denmark have a centralised HMV organization, whereas Sweden, Norway, France and Denmark have registries established more than 15 years ago. A national HCP for complex patients is established in the Netherlands, Sweden, Denmark and Norway (highly dependent on municipalities). Telemedicine is being applied in Italy and France (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Necessarily there will be centres with more experience in patients with neuromuscular disease, some with expertise in chronically critically ill patients, compared with others specialized in integrated programmes for COPD or obesity related respiratory failure.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The diversity of HMV organization throughout Europe demonstrates that no ideal model has yet been found. However we should move towards a more uniform pathway in order to achieve better outcomes, picking the best experiences from each country and constructing a more balanced European HMV network.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Given the increasing numbers of patients, a European Observatory for HMV could serve as a tool to set up the standards.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Accreditation of HMV units in Europe requires consideration to ensure equal access to treatment for patients, based on knowledge, best practices and justice among geographical distribution.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Country(prevalence year) (reference number) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Prevalence \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Centralised Registry \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Organization \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">National Home Care Package \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Telemonitoring \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Netherlands (2017)<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19/100,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No (In the Regional centres) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 HMV centres \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">France (2013)<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96/100,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes (Observatory ANTADIR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Network \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sweden (2002)<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">18</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.5/100,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Network \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Italy (2017)<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23/100,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Network \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes (North) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Denmark (2016)<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.2/100,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No (In the Regional centres) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 HMV centres \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Norway (2007)<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.9/100,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 advisory unit and Network \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2343053.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Number of organizational aspects of some European countries.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0110" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Indications of home assisted ventilation by tracheostomy for non-paralytic chronic respiratory insufficient patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. 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Year/Month | Html | Total | |
---|---|---|---|
2024 November | 10 | 3 | 13 |
2024 October | 106 | 26 | 132 |
2024 September | 86 | 32 | 118 |
2024 August | 100 | 46 | 146 |
2024 July | 76 | 34 | 110 |
2024 June | 89 | 35 | 124 |
2024 May | 109 | 37 | 146 |
2024 April | 71 | 32 | 103 |
2024 March | 56 | 26 | 82 |
2024 February | 55 | 25 | 80 |
2023 December | 1 | 2 | 3 |
2023 October | 2 | 0 | 2 |
2023 March | 24 | 6 | 30 |
2023 February | 103 | 31 | 134 |
2023 January | 82 | 43 | 125 |
2022 December | 94 | 37 | 131 |
2022 November | 101 | 33 | 134 |
2022 October | 86 | 45 | 131 |
2022 September | 61 | 39 | 100 |
2022 August | 58 | 56 | 114 |
2022 July | 49 | 49 | 98 |
2022 June | 47 | 37 | 84 |
2022 May | 65 | 43 | 108 |
2022 April | 55 | 30 | 85 |
2022 March | 48 | 32 | 80 |
2022 February | 24 | 18 | 42 |
2021 June | 1 | 2 | 3 |
2020 December | 2 | 2 | 4 |
2020 July | 27 | 10 | 37 |
2020 June | 61 | 14 | 75 |
2020 May | 77 | 39 | 116 |
2020 April | 311 | 106 | 417 |
2020 March | 39 | 19 | 58 |
2020 February | 34 | 14 | 48 |
2020 January | 36 | 19 | 55 |
2019 December | 66 | 16 | 82 |
2019 November | 29 | 19 | 48 |
2019 October | 63 | 35 | 98 |
2019 September | 95 | 39 | 134 |
2019 August | 223 | 40 | 263 |