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    "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>&#59; it remained under-utilized and restricted to specialized centres in France&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Due to the transition to non-invasive ventilator support&#44; patients under Home Mechanical Ventilation &#40;HMV&#41; have grown worldwide&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Indeed&#44; HMV became widespread in Europe and a survey &#40;Eurovent&#41; presenting data from 2001 to 2002 in 16 European countries &#40;including a total of 483 centres&#41;&#44; showed a global prevalence of 6&#46;6 per 100&#44;000 with a wide variation between countries&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In 2010&#44; the European COPD audit &#40;surveying 13 countries&#41;&#44; showed that although a majority of centres offered invasive and noninvasive ventilation&#44; 40&#46;5&#37; of centres declared not to have the capacity to ventilate at home all eligible patients&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In fact&#44; organization varies widely in Europe&#44; in countries like Denmark&#44; where patients are referred to only 2 respiratory care units &#40;RCU&#41;<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 &#40;Swedevox&#41;&#44; owned by the Swedish Society of Chest Medicine and financially supported by the National Board of Health and Welfare&#46;<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&#44; monitoring&#44; and securing valid prescription and management of both HMV and Longterm Oxygen Therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In 2011&#44; the British Thoracic Society Respiratory Critical Care Group&#44; strongly suggested that National registries should be implemented to reduce variations in care and improve patient safety&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In a recent cross-national&#44; cross-sectional study comparing one Australian and one Canadian predominantly publicly funded HMV services&#44; there were marked regional differences in the clinical characteristics of individuals receiving assisted ventilation and the care practices used to support them&#46; Yet&#44; in spite of these differences Health Related Quality of Life was not different between the two sites&#46; There were also considerable differences in the proportions of individuals using invasive ventilation&#44; and undergoing PSG&#44; home implementation of NIV&#44; or using routine airway clearance techniques&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Based on assistance activities&#44; technical and human resources&#44; accredited training in ventilation&#44; teaching and research activity the Spanish society of Pulmonology &#40;SEPAR&#41; has recently established the minimum requirements for a HMV centre&#44; defining basic units &#40;BU&#41;&#44; Specialized Units &#40;SU&#41; and High Complexity Multidisciplinary Units &#40;HCMU&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">10&#44;11</span></a> Currently there are in Spain&#44; 13 HCMU&#44; 12 SU and 9 BU&#46;<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 &#40;60&#37; response rate&#41; in 3 HCMU&#44; 14 SU and 1 BU&#46;<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&#44; 3 types of centres are defined&#58; weaning centre&#44; HMV centre with expertise in invasive HMV and HMV centre with special focus on NIV&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">14</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Additionally&#44; the network &#8220;WeanNet&#8221;&#44; founded in 2007 within the German Society of Pneumology and Respiratory Medicine &#40;DGP&#41;&#44; has undergone a certification process and by October 2018&#44; 53 weaning centres have been certified&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">For complex patients &#40;like invasively ventilated or under 24<span class="elsevierStyleHsp" style=""></span>h noninvasive ventilatory support&#41; a home care package &#40;including professional caregivers&#41; is highly recommended&#46; However&#44; an adequate home care package &#40;HCP&#41; 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&#46;</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>&#46; Countries like the Netherlands and Denmark have a centralised HMV organization&#44; whereas Sweden&#44; Norway&#44; France and Denmark have registries established more than 15 years ago&#46; A national HCP for complex patients is established in the Netherlands&#44; Sweden&#44; Denmark and Norway &#40;highly dependent on municipalities&#41;&#46; Telemedicine is being applied in Italy and France &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Necessarily there will be centres with more experience in patients with neuromuscular disease&#44; some with expertise in chronically critically ill patients&#44; compared with others specialized in integrated programmes for COPD or obesity related respiratory failure&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The diversity of HMV organization throughout Europe demonstrates that no ideal model has yet been found&#46; However we should move towards a more uniform pathway in order to achieve better outcomes&#44; picking the best experiences from each country and constructing a more balanced European HMV network&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Given the increasing numbers of patients&#44; a European Observatory for HMV could serve as a tool to set up the standards&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Accreditation of HMV units in Europe requires consideration to ensure equal access to treatment for patients&#44; based on knowledge&#44; best practices and justice among geographical distribution&#46;</p></span>"
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                  \t\t\t\t">Netherlands &#40;2017&#41;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a>&nbsp;\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&#47;100&#44;000&nbsp;\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 &#40;In the Regional centres&#41;&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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 &#40;2013&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a>&nbsp;\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&#47;100&#44;000&nbsp;\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 &#40;Observatory ANTADIR&#41;&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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 &#40;2002&#41;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">18</span></a>&nbsp;\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&#46;5&#47;100&#44;000&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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 &#40;2017&#41;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a>&nbsp;\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&#47;100&#44;000&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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 &#40;North&#41;&nbsp;\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 &#40;2016&#41;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a>&nbsp;\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&#46;2&#47;100&#44;000&nbsp;\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 &#40;In the Regional centres&#41;&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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 &#40;2007&#41;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a>&nbsp;\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&#46;9&#47;100&#44;000&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab2343053.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Number of organizational aspects of some European countries&#46;</p>"
        ]
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    ]
    "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 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46; Robert"
                            1 => "G&#46; Fournier"
                            2 => "L&#46; Thomas"
                            3 => "M&#46; G&#233;rard"
                            4 => "B&#46; Chemorin"
                            5 => "A&#46; Bertoye"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Fr Mal Respir"
                        "fecha" => "1979"
                        "volumen" => "7"
                        "paginaInicial" => "353"
                        "paginaFinal" => "355"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/398551"
                            "web" => "Medline"
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                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Home mechanical ventilation&#58; a 12-year population-based retrospective cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Povitz"
                            1 => "L&#46; Rose"
                            2 => "S&#46;Z&#46; Shariff"
                            3 => "S&#46; Leonard"
                            4 => "B&#46; Welk"
                            5 => "K&#46;B&#46; Jenkyn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                      "doi" => "10.4187/respcare.05689"
                      "Revista" => array:6 [
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                            "web" => "Medline"
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                ]
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            ]
            2 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patterns of home mechanical ventilation use in Europe&#58; results from the Eurovent survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;J&#46; Lloyd-Owen"
                            1 => "G&#46;C&#46; Donaldson"
                            2 => "N&#46; Ambrosino"
                            3 => "J&#46; Escarabill"
                            4 => "R&#46; Farre"
                            5 => "B&#46; Fauroux"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.05.00066704"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
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                        "volumen" => "25"
                        "paginaInicial" => "1025"
                        "paginaFinal" => "1031"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15929957"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Variability of hospital resources for acute care of COPD patients&#58; the European COPD Audit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;L&#46; L&#243;pez-Campos"
                            1 => "S&#46; Hartl"
                            2 => "F&#46; Pozo-Rodriguez"
                            3 => "C&#46;M&#46; Roberts"
                            4 => "European COPD Audit Team"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00074413"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
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                        "volumen" => "43"
                        "paginaInicial" => "754"
                        "paginaFinal" => "762"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23988775"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Survival in ALS with home mechanical ventilation non-invasively and invasively&#58; a 15-year cohort study in west Denmark"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Dreyer"
                            1 => "C&#46;K&#46; Lorenzen"
                            2 => "L&#46; Schou"
                            3 => "M&#46; Felding"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/21678421.2013.837929"
                      "Revista" => array:6 [
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                        "volumen" => "15"
                        "paginaInicial" => "62"
                        "paginaFinal" => "67"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24067168"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Home mechanical ventilation in Sweden&#44; with reference to Danish experiences"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46; Midgren"
                            1 => "J&#46; Olofson"
                            2 => "R&#46; Harlid"
                            3 => "C&#46; Dellborg"
                            4 => "E&#46; Jacobsen"
                            5 => "O&#46; Norregaard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/rmed.1999.0699"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Med"
                        "fecha" => "2000"
                        "volumen" => "94"
                        "paginaInicial" => "135"
                        "paginaFinal" => "138"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10714418"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A nationwide structure for valid long-term oxygen therapy&#58; 29-year prospective data in Sweden"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Ekstr&#246;m"
                            1 => "Z&#46; Ahmadi"
                            2 => "H&#46; Larsson"
                            3 => "T&#46; Nilsson"
                            4 => "J&#46; Wahlberg"
                            5 => "K&#46;E&#46; Str&#246;m"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2147/COPD.S140264"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Chron Obstruct Pulmon Dis"
                        "fecha" => "2017"
                        "volumen" => "12"
                        "paginaInicial" => "3159"
                        "paginaFinal" => "3169"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29133978"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Home mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;P&#46; Wise"
                            1 => "N&#46; Hart"
                            2 => "C&#46; Davidson"
                            3 => "R&#46; Fox"
                            4 => "M&#46; Allen"
                            5 => "M&#46; Elliott"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.d1687"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2011"
                        "volumen" => "342"
                        "paginaInicial" => "d1687"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21471174"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "9"
              "referencia" => array:1 [
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Editorial
Organization of Home Mechanical Ventilation in Europe: A Plea for Uniformity and Accreditation
Manejo de la ventilación mecánica domiciliaria en Europa: Tiempo de unificar y acreditar
João Carlos Winck
Faculty of Medicine, Porto University, Centro de Reabilitação do Norte, Portugal
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    "titulo" => "Organization of Home Mechanical Ventilation in Europe&#58; A Plea for Uniformity and Accreditation"
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    "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>&#59; it remained under-utilized and restricted to specialized centres in France&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Due to the transition to non-invasive ventilator support&#44; patients under Home Mechanical Ventilation &#40;HMV&#41; have grown worldwide&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Indeed&#44; HMV became widespread in Europe and a survey &#40;Eurovent&#41; presenting data from 2001 to 2002 in 16 European countries &#40;including a total of 483 centres&#41;&#44; showed a global prevalence of 6&#46;6 per 100&#44;000 with a wide variation between countries&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In 2010&#44; the European COPD audit &#40;surveying 13 countries&#41;&#44; showed that although a majority of centres offered invasive and noninvasive ventilation&#44; 40&#46;5&#37; of centres declared not to have the capacity to ventilate at home all eligible patients&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In fact&#44; organization varies widely in Europe&#44; in countries like Denmark&#44; where patients are referred to only 2 respiratory care units &#40;RCU&#41;<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 &#40;Swedevox&#41;&#44; owned by the Swedish Society of Chest Medicine and financially supported by the National Board of Health and Welfare&#46;<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&#44; monitoring&#44; and securing valid prescription and management of both HMV and Longterm Oxygen Therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In 2011&#44; the British Thoracic Society Respiratory Critical Care Group&#44; strongly suggested that National registries should be implemented to reduce variations in care and improve patient safety&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In a recent cross-national&#44; cross-sectional study comparing one Australian and one Canadian predominantly publicly funded HMV services&#44; there were marked regional differences in the clinical characteristics of individuals receiving assisted ventilation and the care practices used to support them&#46; Yet&#44; in spite of these differences Health Related Quality of Life was not different between the two sites&#46; There were also considerable differences in the proportions of individuals using invasive ventilation&#44; and undergoing PSG&#44; home implementation of NIV&#44; or using routine airway clearance techniques&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Based on assistance activities&#44; technical and human resources&#44; accredited training in ventilation&#44; teaching and research activity the Spanish society of Pulmonology &#40;SEPAR&#41; has recently established the minimum requirements for a HMV centre&#44; defining basic units &#40;BU&#41;&#44; Specialized Units &#40;SU&#41; and High Complexity Multidisciplinary Units &#40;HCMU&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">10&#44;11</span></a> Currently there are in Spain&#44; 13 HCMU&#44; 12 SU and 9 BU&#46;<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 &#40;60&#37; response rate&#41; in 3 HCMU&#44; 14 SU and 1 BU&#46;<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&#44; 3 types of centres are defined&#58; weaning centre&#44; HMV centre with expertise in invasive HMV and HMV centre with special focus on NIV&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">14</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Additionally&#44; the network &#8220;WeanNet&#8221;&#44; founded in 2007 within the German Society of Pneumology and Respiratory Medicine &#40;DGP&#41;&#44; has undergone a certification process and by October 2018&#44; 53 weaning centres have been certified&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">For complex patients &#40;like invasively ventilated or under 24<span class="elsevierStyleHsp" style=""></span>h noninvasive ventilatory support&#41; a home care package &#40;including professional caregivers&#41; is highly recommended&#46; However&#44; an adequate home care package &#40;HCP&#41; 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&#46;</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>&#46; Countries like the Netherlands and Denmark have a centralised HMV organization&#44; whereas Sweden&#44; Norway&#44; France and Denmark have registries established more than 15 years ago&#46; A national HCP for complex patients is established in the Netherlands&#44; Sweden&#44; Denmark and Norway &#40;highly dependent on municipalities&#41;&#46; Telemedicine is being applied in Italy and France &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Necessarily there will be centres with more experience in patients with neuromuscular disease&#44; some with expertise in chronically critically ill patients&#44; compared with others specialized in integrated programmes for COPD or obesity related respiratory failure&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The diversity of HMV organization throughout Europe demonstrates that no ideal model has yet been found&#46; However we should move towards a more uniform pathway in order to achieve better outcomes&#44; picking the best experiences from each country and constructing a more balanced European HMV network&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Given the increasing numbers of patients&#44; a European Observatory for HMV could serve as a tool to set up the standards&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Accreditation of HMV units in Europe requires consideration to ensure equal access to treatment for patients&#44; based on knowledge&#44; best practices and justice among geographical distribution&#46;</p></span>"
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                  <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&#40;prevalence year&#41; &#40;reference number&#41;&nbsp;\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
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Prevalence&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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&nbsp;\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 &#40;2017&#41;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a>&nbsp;\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&#47;100&#44;000&nbsp;\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 &#40;In the Regional centres&#41;&nbsp;\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
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                  \t\t\t\t">4 HMV centres&nbsp;\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
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                  \t\t\t\t">Yes&nbsp;\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&nbsp;\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 &#40;2013&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">96&#47;100&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Yes &#40;Observatory ANTADIR&#41;&nbsp;\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&nbsp;\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
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                  \t\t\t\t">No&nbsp;\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
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                  \t\t\t\t">Yes&nbsp;\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 &#40;2002&#41;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">18</span></a>&nbsp;\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
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                  \t\t\t\t">10&#46;5&#47;100&#44;000&nbsp;\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
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                  \t\t\t\t">Yes&nbsp;\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
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                  \t\t\t\t">Network&nbsp;\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
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                  \t\t\t\t">Yes&nbsp;\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
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                  \t\t\t\t">No&nbsp;\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 &#40;2017&#41;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a>&nbsp;\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&#47;100&#44;000&nbsp;\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
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                  \t\t\t\t">No&nbsp;\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
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                  \t\t\t\t">Network&nbsp;\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
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                  \t\t\t\t">No&nbsp;\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
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                  \t\t\t\t">Yes &#40;North&#41;&nbsp;\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
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                  \t\t\t\t">Denmark &#40;2016&#41;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a>&nbsp;\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&#46;2&#47;100&#44;000&nbsp;\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
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                  \t\t\t\t">No &#40;In the Regional centres&#41;&nbsp;\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
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                  \t\t\t\t">2 HMV centres&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 advisory unit and Network&nbsp;\t\t\t\t\t\t\n
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Article information
ISSN: 03002896
Original language: English
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