Publique en esta revista
Información de la revista
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Editorial
DOI: 10.1016/j.arbres.2019.07.012
Open Access
Disponible online el 13 de Agosto de 2019
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
Visitas
0
João Carlos Winck
Faculty of Medicine, Porto University, Centro de Reabilitação do Norte, Portugal
Este artículo ha recibido
0
Visitas

Under a Creative Commons license
Información del artículo
Texto completo
Bibliografía
Descargar PDF
Estadísticas
Tablas (1)
Table 1. Number of organizational aspects of some European countries.
Texto completo

Home Mechanical Ventilation in Europe started as tracheostomy ventilation in the late 1970s1; it remained under-utilized and restricted to specialized centres in France.

Due to the transition to non-invasive ventilator support, patients under Home Mechanical Ventilation (HMV) have grown worldwide.2

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.3

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.4

In fact, organization varies widely in Europe, in countries like Denmark, where patients are referred to only 2 respiratory care units (RCU)5 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.6

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.7

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.8

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.9

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).10,11 Currently there are in Spain, 13 HCMU, 12 SU and 9 BU.12

In Portugal based on the same criteria we have characterized 18 HMV units (60% response rate) in 3 HCMU, 14 SU and 1 BU.13

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.14

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.15

For complex patients (like invasively ventilated or under 24h 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.

The table included shows a number of organizational aspects of some European countries together with the most recent available prevalence of HMV16-21. 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 (Table 1).

Table 1.

Number of organizational aspects of some European countries.

Country(prevalence year) (reference number)  Prevalence  Centralised Registry  Organization  National Home Care Package  Telemonitoring 
Netherlands (2017)16  19/100,000  No (In the Regional centres)  4 HMV centres  Yes  No 
France (2013)17  96/100,000  Yes (Observatory ANTADIR)  Network  No  Yes 
Sweden (2002)18  10.5/100,000  Yes  Network  Yes  No 
Italy (2017)19  23/100,000  No  Network  No  Yes (North) 
Denmark (2016)20  57.2/100,000  No (In the Regional centres)  2 HMV centres  Yes  No 
Norway (2007)21  19.9/100,000  Yes  1 advisory unit and Network  Yes  No 

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.

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.

Given the increasing numbers of patients, a European Observatory for HMV could serve as a tool to set up the standards.

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.

References
[1]
D. Robert, G. Fournier, L. Thomas, M. Gérard, B. Chemorin, A. Bertoye.
Indications of home assisted ventilation by tracheostomy for non-paralytic chronic respiratory insufficient patients.
Rev Fr Mal Respir, 7 (1979), pp. 353-355
[2]
M. Povitz, L. Rose, S.Z. Shariff, S. Leonard, B. Welk, K.B. Jenkyn, et al.
Home mechanical ventilation: a 12-year population-based retrospective cohort study.
Respir Care, 63 (2018), pp. 380-438
[3]
S.J. Lloyd-Owen, G.C. Donaldson, N. Ambrosino, J. Escarabill, R. Farre, B. Fauroux, et al.
Patterns of home mechanical ventilation use in Europe: results from the Eurovent survey.
Eur Respir J, 25 (2005), pp. 1025-1031
[4]
J.L. López-Campos, S. Hartl, F. Pozo-Rodriguez, C.M. Roberts, European COPD Audit Team.
Variability of hospital resources for acute care of COPD patients: the European COPD Audit.
Eur Respir J, 43 (2014), pp. 754-762
[5]
P. Dreyer, C.K. Lorenzen, L. Schou, M. Felding.
Survival in ALS with home mechanical ventilation non-invasively and invasively: a 15-year cohort study in west Denmark.
Amyotroph Lateral Scler Frontotemporal Degener, 15 (2014), pp. 62-67
[6]
B. Midgren, J. Olofson, R. Harlid, C. Dellborg, E. Jacobsen, O. Norregaard.
Home mechanical ventilation in Sweden, with reference to Danish experiences.
Respir Med, 94 (2000), pp. 135-138
[7]
M. Ekström, Z. Ahmadi, H. Larsson, T. Nilsson, J. Wahlberg, K.E. Ström, et al.
A nationwide structure for valid long-term oxygen therapy: 29-year prospective data in Sweden.
Int J Chron Obstruct Pulmon Dis, 12 (2017), pp. 3159-3169
[8]
M.P. Wise, N. Hart, C. Davidson, R. Fox, M. Allen, M. Elliott, et al.
Home mechanical ventilation.
BMJ, 342 (2011), pp. d1687
[9]
L.M. Hannan, H. Sahi, J.D. Road, C.F. McDonald, D.J. Berlowitz, M.E. Howard.
Care practices and health-related quality of life for individuals receiving assisted ventilation. A cross-national study.
Ann Am Thorac Soc, 13 (2016), pp. 894-903
[10]
J. Terán Santos.
Accreditation for units treating sleep disorders in respiratory medicine.
Arch Bronconeumol, 45 (2009), pp. 263-265
[11]
F.L. Márquez Pérez, A. Capelastegui Saiz.
Acreditación SEPAR de unidades monográficas Qué nos dice RECALAR.
Monogr Arch Bronconeumol, (2018), pp. 00155
[13]
A. Mineiro, M.J. Guimarães, J.C. Winck.
Organization of home mechanical ventilation in Portugal: characterization of current centers and a pathway to uniformization.
[14]
W. Windisch, J. Geiseler, K. Simon, S. Walterspacher, M. Dreher, on behalf of the Guideline Commission.
German National Guideline for treating chronic respiratory failure with invasive and non-invasive ventilation: revised edition 2017 – Part 1.
Respiration, 96 (2018), pp. 66-97
[15]
B. Schönhofer.
WeanNet: the network of respiratory weaning centers.
Pneumologie, 73 (2019), pp. 74-80
[16]
P. Wijstra.
Personal communication.
Journées internationales de ventilation à domicilie (JIVD), (2018),
[17]
J.C. Borel.
Personal communication.
Journées internationales de ventilation à domicilie (JIVD), (2018),
[18]
M. Laub, S. Berg, B. Midgren, Swedish Society of Chest Medicine.
Home mechanical ventilation in Sweden – inequalities within a homogenous health care system.
Respir Med, 98 (2004), pp. 38-42
[19]
V. Galavotti, G. Garuti, M. Vitacca, B. Balbi, M. Carone, G. Idotta, et al.
Type and prevalence of home care services in patients suffering from chronic respiratory diseases: AIPO national survey.
Rassegna di Patologia dell’Apparato Respiratorio, 32 (2017), pp. 94-101
[20]
Ole Norregard. Personal data; 2019.
[21]
E. Tollefsen, A. Gulsvik, P. Bakke, O. Fondenes.
Prevalence of home ventilation therapy in Norway.
Tidsskr Nor Laegeforen, 129 (2009), pp. 2094-2097
Copyright © 2019. The Author
Idiomas
Archivos de Bronconeumología

Suscríbase a la newsletter

Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.